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General NPI Number Information
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NPI Number | 1407132483
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Entity Type | Organization
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Legal Business Name | DO ORIENTAL MEDICAL GROUP
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Dates
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Enumeration Date | 10/22/2011
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 430 MONTEREY AVE STE 1B
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City | LOS GATOS
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State | CA
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Zip | 95030-5323
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Country | US
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Telephone | 408-399-9888
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Fax | 408-399-9888
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Provider Business Mailing Address
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Address Line | 430 MONTEREY AVE STE 1B
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City | LOS GATOS
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State | CA
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Zip | 95030-5323
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Country | US
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Telephone | 408-399-9888
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Fax | 408-399-9888
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | SUE JING WANG
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Credential | AC
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Telephone | 408-399-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 14157
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License Number State | CA
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