=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528458726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGICAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2015
-----------------------------------------------------
Last Update Date | 01/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10062 MILLER AVE #220
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-3494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-377-5589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10062 MILLER AVE #220
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014-3494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-377-5589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SHIMING WANG
-----------------------------------------------------
Credential | BACHELOR
-----------------------------------------------------
Telephone | 415-377-5589
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC15402
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------