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General NPI Number Information
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NPI Number | 1730719097
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Entity Type | Organization
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Legal Business Name | NOURISH HERB & ACUPUNCTURE LLC
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 10761 163RD PL # 1B
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City | ORLAND PARK
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State | IL
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Zip | 60467-8861
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Country | US
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Telephone | 312-804-2461
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Fax |
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Provider Business Mailing Address
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Address Line | 2545 S HILLOCK AVE
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City | CHICAGO
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State | IL
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Zip | 60608-5736
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Country | US
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Telephone | 312-804-2461
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | YOU GUANG HUYNH
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Credential |
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Telephone | 312-804-2461
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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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