MEDICARE: WILLOW ACUPUNCTURE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1336681907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW ACUPUNCTURE CLINIC

Provider Business Mailing Address
First Line	:	1916 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-1106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-1106
Country	:	US
Telephone Number	:	619-808-3198
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HELENA CHOE
Credential	:
Telephone Number	:	619-808-3198

Provider Enumeration Date	:	11/13/2016
Last Update Date	:	11/16/2016

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