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General NPI Number Information
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NPI Number | 1508684473
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Entity Type | Organization
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Legal Business Name | EVERGREEN EAST ASIAN MEDICINE LLC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 7025 N 57TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-2517
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Country | US
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Telephone | 623-243-5195
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Fax |
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Provider Business Mailing Address
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Address Line | 7025 N 57TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-2517
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Country | US
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Telephone | 623-243-5195
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. THANH NGUYEN
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Credential | DSOM
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Telephone | 602-653-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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