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General NPI Number Information
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NPI Number | 1770931917
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Entity Type | Organization
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Legal Business Name | THRIVE ACUPUNCTURE GROUP, INC.
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 1137 TASMAN DR
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City | SUNNYVALE
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State | CA
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Zip | 94089-2228
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Country | US
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Telephone | 408-541-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 1137 TASMAN DR
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City | SUNNYVALE
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State | CA
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Zip | 94089-2228
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Country | US
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Telephone | 408-541-0188
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/OWNER
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Name | MISS TIFFANY A. WANG
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Credential | LAC.
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Telephone | 408-541-0188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | AC15794
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License Number State | CA
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