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General NPI Number Information
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NPI Number | 1740058809
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Entity Type | Organization
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Legal Business Name | WAVY ACUPUNCTURE INC
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 1000 JOHNSON FERRY RD STE B115
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City | MARIETTA
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State | GA
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Zip | 30068-2111
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Country | US
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Telephone | 770-589-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 3976 KINGSLEY PARK CT
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30096-2434
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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 | GENERAL MANAGER
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Name | DANIEL KIM
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Credential |
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Telephone | 770-589-1233
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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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