MEDICARE: UPTOWN 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	AC8484	CA

General Provider Information

NPI Number	:	1689033912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPTOWN ACUPUNCTURE INC.

Provider Business Mailing Address
First Line	:	1286 UNIVERSITY AVE # 504
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3312
Country	:	US
Telephone Number	:	619-339-9980
Fax Number	:	619-800-7000

Provider Business Practice Location Address
First Line	:	842 WASHINGTON ST STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2214
Country	:	US
Telephone Number	:	619-800-7000
Fax Number	:	619-800-7000

Authorized Official
Title or Position	:	OWNER
Name	:	KIRK ROBERT PFEIFFER
Credential	:	L.AC.
Telephone Number	:	619-339-9980

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/15/2016

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