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General NPI Number Information
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NPI Number | 1417403031
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Entity Type | Organization
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Legal Business Name | SHANGHAI ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 284 S MAIN STREET SUITE 1200
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City | ALPHARETTA
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State | GA
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Zip | 30009-1981
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Country | US
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Telephone | 678-374-1963
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Fax | 678-374-1963
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Provider Business Mailing Address
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Address Line | 11240 ABBOTTS STATION DR
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City | DULUTH
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State | GA
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Zip | 30097-5717
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Country | US
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Telephone | 404-402-9007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. YUSHENG QIAO
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Credential | L. AC.
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Telephone | 404-402-9007
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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 | 14
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License Number State | GA
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