=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982218129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHINESE MEDICINE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2020
-----------------------------------------------------
Last Update Date | 09/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 TERRY DR STE 18
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-488-7896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 TERRY DR STE 18
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-488-7896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | DR. XIN YAO WANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-262-7983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------