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General NPI Number Information
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NPI Number | 1548945736
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Entity Type | Organization
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Legal Business Name | ALPHA ACUPUNCTURE & HERB CLINIC
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 08/19/2023
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Provider Practice Location Address
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Address Line | 4340 REDWOOD HWY STE A-26
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City | SAN RAFAEL
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State | CA
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Zip | 94903
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Country | US
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Telephone | 415-910-9351
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Fax |
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Provider Business Mailing Address
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Address Line | 4340 REDWOOD HWY STE A-26
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City | SAN RAFAEL
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State | CA
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Zip | 94903
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Country | US
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Telephone | 415-910-9351
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Fax |
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Authorized Official
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Title or Position | SELF-EMPLOYMENT
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Name | SUNGHWAN KIM
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Credential | LAC
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Telephone | 415-910-9351
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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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