MEDICARE: BODY-MIND ACUPUNCTURE

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	15419	CA

General Provider Information

NPI Number	:	1689086993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY-MIND ACUPUNCTURE

Provider Business Mailing Address
First Line	:	9409 POINSETTIA AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-2268
Country	:	US
Telephone Number	:	714-200-8817
Fax Number	:

Provider Business Practice Location Address
First Line	:	9409 POINSETTIA AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-2268
Country	:	US
Telephone Number	:	714-200-8817
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOTIKA HUY TRUONG
Credential	:	L.AC
Telephone Number	:	714-200-8817

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	05/21/2014

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Directions to “BODY-MIND ACUPUNCTURE ” Practice Location

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