MEDICARE: AUTHENTIC ORIENTAL HEALTHCARE, LLC

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	AP 1914	FL

General Provider Information

NPI Number	:	1427451426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTHENTIC ORIENTAL HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	118 LAKE EMMA COVE DR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2545
Country	:	US
Telephone Number	:	407-690-7696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 S VOLUSIA AVE STE C4
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7626
Country	:	US
Telephone Number	:	407-690-7696
Fax Number	:	407-610-0287

Authorized Official
Title or Position	:	CEO
Name	:	MENGLAN CHEN
Credential	:
Telephone Number	:	407-690-7696

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	09/08/2020

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