MEDICARE: HUNTINGTON TRADITIONAL CHINESE MEDICINE CLINIC

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	302R00000X	Health Maintenance Organization	AC 12207	CA

General Provider Information

NPI Number	:	1982098455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTINGTON TRADITIONAL CHINESE MEDICINE CLINIC

Provider Business Mailing Address
First Line	:	2130 HUNTINGTON DR STE 313
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4980
Country	:	US
Telephone Number	:	626-272-1889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 HUNTINGTON DR STE 313
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4980
Country	:	US
Telephone Number	:	626-272-1889
Fax Number	:

Authorized Official
Title or Position	:	L AC.
Name	:	PROF. GUOHUA XIE
Credential	:
Telephone Number	:	626-272-1889

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	04/18/2025

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