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General NPI Number Information
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NPI Number | 1962992578
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Entity Type | Organization
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Legal Business Name | GOOD LIFE ACUPUNCTURE
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 4205 SAN FELIPE RD STE 210
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City | SAN JOSE
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State | CA
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Zip | 95135-1550
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Country | US
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Telephone | 408-250-1408
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 GUMDROP DR
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City | SAN JOSE
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State | CA
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Zip | 95148-2022
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Country | US
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Telephone | 408-831-8084
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIMOTHY MCCONNELL
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Credential | L.AC.
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Telephone | 408-831-8084
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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 | 17797
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License Number State | CA
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