MEDICARE: PROJECT HUB

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	:	1699276055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT HUB

Provider Business Mailing Address
First Line	:	839 WINIFRED DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	839 WINIFRED DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3345
Country	:	US
Telephone Number	:	415-734-6852
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	BAOWEN MIAO
Credential	:	LAC
Telephone Number	:	415-734-6852

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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Directions to “PROJECT HUB ” Practice Location

Language	Start Address	Practice Location

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