=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568937415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLD GINSENG HERB AND ACUPUNCTURE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2018
-----------------------------------------------------
Last Update Date | 08/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4001 NEWBERRY RD STE C4
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32607-2380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-378-4667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4001 NEWBERRY RD STE C4
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32607-2380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HONGCHI CHOU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-378-4667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------