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General NPI Number Information
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NPI Number | 1295906881
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Entity Type | Individual
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Provider Name | YUN GONG L.A.C
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Gender | Female
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 12/23/2011
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Provider Practice Location Address
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Address Line | 2727 WALSH AVENUE SUITE 206 GRACE ACUPUNCTURE HEALTH CENTER INC.
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City | SANTA CLARA
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State | CA
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Zip | 95051
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Country | US
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Telephone | 408-529-3115
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 WALSH AVE SUITE 206
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City | SANTA CLARA
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State | CA
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Zip | 95051-0956
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Country | US
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Telephone | 408-529-3115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | AC12190
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License Number State | CA
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