=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477907137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHANTI ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2016
-----------------------------------------------------
Last Update Date | 04/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7964 ARJONS DR SUITE D
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92126-4392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-461-8538
-----------------------------------------------------
Fax | 858-530-0365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7964 ARJONS DR SUITE D
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92126-4392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-461-8538
-----------------------------------------------------
Fax | 858-530-0365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | MRS. SHANTI DEVI WU
-----------------------------------------------------
Credential | MSTOM, L.AC.
-----------------------------------------------------
Telephone | 858-461-8538
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 13145
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------