MEDICARE: GREENHEALTH ACUPUNCTURE, 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

General Provider Information

NPI Number	:	1639888100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENHEALTH ACUPUNCTURE, INC

Provider Business Mailing Address
First Line	:	1111 W EL CAMINO REAL, SUITE 121
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-1057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 W EL CAMINO REAL, SUITE 121
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-1057
Country	:	US
Telephone Number	:	408-357-4536
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DI LI
Credential	:
Telephone Number	:	408-357-4536

Provider Enumeration Date	:	11/23/2022
Last Update Date	:	11/23/2022

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