MEDICARE: TRADITIONAL 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	:	1639644362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRADITIONAL ACUPUNCTURE CLINIC

Provider Business Mailing Address
First Line	:	5554 NEWBRIAR WAY
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-8799
Country	:	US
Telephone Number	:	626-247-1398
Fax Number	:

Provider Business Practice Location Address
First Line	:	20709 GOLDEN SPRINGS DR
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-3847
Country	:	US
Telephone Number	:	626-247-1398
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	SHANSHAN LIU
Credential	:
Telephone Number	:	626-247-1398

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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Directions to “TRADITIONAL ACUPUNCTURE CLINIC ” Practice Location

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