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General NPI Number Information
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NPI Number | 1730510637
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Entity Type | Organization
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Legal Business Name | XUEWEN ACUPUNCTURE & HERBS MEDICAL SERVICE INC.
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 2620 WALNUT AVE STE A
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City | TUSTIN
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State | CA
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Zip | 92780-7028
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Country | US
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Telephone | 714-838-7575
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Fax | 714-838-8112
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Provider Business Mailing Address
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Address Line | 2620 WALNUT AVE STE A
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City | TUSTIN
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State | CA
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Zip | 92780-7028
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Country | US
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Telephone | 714-838-7575
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Fax | 714-838-8112
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. YONG GUANG MAO
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Credential |
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Telephone | 714-838-7575
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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 | AC15490
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License Number State | CA
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