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General NPI Number Information
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NPI Number | 1265806483
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Entity Type | Organization
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Legal Business Name | NW CLINIC
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Dates
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Enumeration Date | 11/26/2015
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Last Update Date | 11/26/2015
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Provider Practice Location Address
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Address Line | 2060 WALSH AVE STE 101
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City | SANTA CLARA
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State | CA
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Zip | 95050-2568
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Country | US
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Telephone | 650-968-8665
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Fax | 650-968-6286
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Provider Business Mailing Address
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Address Line | 257 CASTRO ST STE 223
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94041-1287
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Country | US
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Telephone | 650-968-8665
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Fax | 650-968-6286
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Authorized Official
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Title or Position | MANAGER
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Name | TINA JIAO
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Credential |
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Telephone | 650-968-8665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC16540
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License Number State | CA
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