=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518367846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDER STONE INTERNATIONAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2014
-----------------------------------------------------
Last Update Date | 08/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46249 WARM SPRINGS BLVE SUITE 1
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-979-9298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46249 WARM SPRINGS BLVE,
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-979-9298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGE
-----------------------------------------------------
Name | MISS XIYAO SHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-979-9298
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 077975
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------