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General NPI Number Information
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NPI Number | 1780962076
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Entity Type | Organization
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Legal Business Name | JADE DRAGON MEDICAL SPA
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 827 BAYSIDE RD
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City | ARCATA
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State | CA
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Zip | 95521-6403
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Country | US
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Telephone | 707-822-4300
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Fax | 707-822-4330
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Provider Business Mailing Address
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Address Line | 827 BAYSIDE RD
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City | ARCATA
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State | CA
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Zip | 95521-6403
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Country | US
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Telephone | 707-822-4300
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Fax | 707-822-4330
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA BAKER
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Credential |
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Telephone | 707-822-4300
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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 | AC12703
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License Number State | CA
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