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General NPI Number Information
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NPI Number | 1518373620
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Entity Type | Organization
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Legal Business Name | LONGEVITY MEDICAL CENTER
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 1630 OAKLAND RD STE A115
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City | SAN JOSE
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State | CA
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Zip | 95131-2461
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Country | US
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Telephone | 408-982-5290
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 OAKLAND RD STE A115
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City | SAN JOSE
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State | CA
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Zip | 95131-2461
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Country | US
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Telephone | 408-982-5290
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GRACE YU
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Credential |
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Telephone | 415-812-6527
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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 | AC15777
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License Number State | CA
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