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General NPI Number Information
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NPI Number | 1396053294
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Entity Type | Organization
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Legal Business Name | ACT ACUPUNCTURE CLINIC CORP
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 40788 FREMONT BLVD
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City | FREMONT
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State | CA
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Zip | 94538-4373
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Country | US
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Telephone | 510-440-1088
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Fax | 510-979-0618
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Provider Business Mailing Address
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Address Line | 40788 FREMONT BLVD
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City | FREMONT
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State | CA
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Zip | 94538-4373
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Country | US
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Telephone | 510-440-1088
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Fax | 510-979-0618
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MS. AIQUN WANG
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Credential | L.AC
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Telephone | 510-440-1088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC4672
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License Number State | CA
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