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General NPI Number Information
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NPI Number | 1609465392
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Entity Type | Organization
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Legal Business Name | TIDELANDS ACUPUNCTURE INC
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 949 BROOKGROVE LN
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City | CUPERTINO
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State | CA
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Zip | 95014-4667
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Country | US
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Telephone | 408-207-8785
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Fax |
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Provider Business Mailing Address
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Address Line | 212 S MORRISON AVE
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City | SAN JOSE
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State | CA
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Zip | 95126-4826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HENGJI LI
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Credential |
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Telephone | 408-207-8785
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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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