=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447949060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YU HERBS AND ACUPUNCTURE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2023
-----------------------------------------------------
Last Update Date | 05/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 WASHINGTON AVE STE 2
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-386-3552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 WASHINGTON AVE STE 2
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-386-3552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | MING HUI LAI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-386-3552
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------