Provider Demographics
NPI:1003287996
Name:TAO ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:TAO ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONG GEUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:480-268-4878
Mailing Address - Street 1:6735 E GREENWAY PKWY APT 1037
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2108
Mailing Address - Country:US
Mailing Address - Phone:480-268-4878
Mailing Address - Fax:
Practice Address - Street 1:15721 N GREENWAY HAYDEN LOOP STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1776
Practice Address - Country:US
Practice Address - Phone:480-268-4878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1005171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty