MEDICARE: PHOENIX HEALTH CARE

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	16212	CA

General Provider Information

NPI Number	:	1679970412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX HEALTH CARE

Provider Business Mailing Address
First Line	:	580 E JULIAN ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-3313
Country	:	US
Telephone Number	:	408-707-3030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1754 TECHNOLOGY DR
Second Line	:	SUITE 102
City	:	SAN JOSE
State	:	CA
Zip	:	95110-1308
Country	:	US
Telephone Number	:	408-707-3030
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST/HERBALIST
Name	:	MR. RAY KIM
Credential	:
Telephone Number	:	408-707-3030

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	11/21/2014

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Directions to “PHOENIX HEALTH CARE ” Practice Location

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