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General NPI Number Information
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NPI Number | 1801332382
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Entity Type | Organization
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Legal Business Name | BAREFOOT TAOISTS
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 2488 NEWPORT BLVD STE B1
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City | COSTA MESA
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State | CA
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Zip | 92627-5196
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Country | US
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Telephone | 925-308-6118
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16054
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City | IRVINE
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State | CA
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Zip | 92623-6054
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Country | US
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Telephone | 925-308-6118
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | JIAN YI YE
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Credential | L.AC
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Telephone | 925-308-6118
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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 | 17275
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License Number State | CA
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