=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255609681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACUENERGY HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2011
-----------------------------------------------------
Last Update Date | 12/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10601 S DE ANZA BLVD SUITE # 305
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-440-0998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4453 LICK MILL BLVD
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95054-3589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | CONNIE CHENG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-440-0998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 171100000X
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------