=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881137222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAVEN MAN INTEGRATED HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2016
-----------------------------------------------------
Last Update Date | 12/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 373 S MONROE ST STE 301
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-334-1463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 373 S MONROE ST STE 301
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-334-1463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | YANZHONG ZHU
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 831-334-1463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC7892
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------