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General NPI Number Information
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NPI Number | 1629444872
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Entity Type | Organization
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Legal Business Name | MIRACLE ACUPUNCTURE PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14127 CAPRI DR SUITE 5A
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City | LOS GATOS
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State | CA
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Zip | 95032-1534
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Country | US
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Telephone | 408-726-6375
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Fax | 855-856-6747
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Provider Business Mailing Address
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Address Line | 1032 W HEDDING ST
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City | SAN JOSE
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State | CA
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Zip | 95126-1217
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Country | US
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Telephone | 408-726-6375
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SIHEON LEE
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Credential | L.AC
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Telephone | 408-726-6375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | CA
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