MEDICARE: MA'S ACUPUNCTURE & CHINESE MEDICINE AT BELLEVUE, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000000000	OTHER	WA	ACUPUNCTURIST

General Provider Information

NPI Number	:	1962961532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MA'S ACUPUNCTURE & CHINESE MEDICINE AT BELLEVUE, INC

Provider Business Mailing Address
First Line	:	1540 140TH AVE NE STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-4579
Country	:	US
Telephone Number	:	425-502-9256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 140TH AVE NE STE 100
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-4579
Country	:	US
Telephone Number	:	425-502-9256
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARLENA MA
Credential	:
Telephone Number	:	425-502-9256

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/19/2019

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