MEDICARE: NINA SKIN CARE, INC.

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	AC01109	TX

General Provider Information

NPI Number	:	1619315306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NINA SKIN CARE, INC.

Provider Business Mailing Address
First Line	:	7423 BURNET RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-2244
Country	:	US
Telephone Number	:	512-450-1595
Fax Number	:

Provider Business Practice Location Address
First Line	:	7423 BURNET RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-2244
Country	:	US
Telephone Number	:	512-450-1595
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. YEN KAM SIU
Credential	:	ACUPUNCTURIST
Telephone Number	:	512-450-1595

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	06/05/2013

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