=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538650478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIDDEN DRAGON HEALING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2018
-----------------------------------------------------
Last Update Date | 05/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 INTERNATIONAL PKWY STE 250-8
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-5056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-681-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 E WILBUR AVE UNIT 45
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-3226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-681-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURE PHYSICIAN
-----------------------------------------------------
Name | DR. KIMBERLY DENNIESE BARNES
-----------------------------------------------------
Credential | O.M.D. L.AC.
-----------------------------------------------------
Telephone | 954-681-3100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | AP3938
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------