MEDICARE: DIA MAC AC

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	AC3406	CA

General Provider Information

NPI Number	:	1497853824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIA MAC AC

Provider Business Mailing Address
First Line	:	3005 SILVER CREEK #142
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121
Country	:	US
Telephone Number	:	408-227-9088
Fax Number	:	408-227-9102

Provider Business Practice Location Address
First Line	:	3005 SILVER CREEK RD #142
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-0005
Country	:	US
Telephone Number	:	408-227-9088
Fax Number	:	408-227-9102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/22/2010

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