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General NPI Number Information
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NPI Number | 1871981050
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Entity Type | Organization
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Legal Business Name | METTA GROVE
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 2615 ASHBY AVE
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City | BERKELEY
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State | CA
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Zip | 94705-2200
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Country | US
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Telephone | 510-207-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 1739 DWIGHT WAY
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City | BERKELEY
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State | CA
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Zip | 94703-1963
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Country | US
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Telephone | 510-207-7162
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MR. LOC T HUYNH
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Credential | L.AC.
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Telephone | 510-207-7162
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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 | 15161
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License Number State | CA
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