=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568105005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORIENTAL MEDICAL ARTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2022
-----------------------------------------------------
Last Update Date | 04/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10310 N 138TH EAST AVE STE 206
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-4604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-841-7150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11105 N 132ND EAST AVE
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-6065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-841-7150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HONGMEI MA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 918-841-7150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------