Provider Demographics
NPI:1073046058
Name:SUPER ACUCARE
Entity Type:Organization
Organization Name:SUPER ACUCARE
Other - Org Name:HUA XIANG ACUCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HUA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:267-257-4515
Mailing Address - Street 1:46 N 10TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3005
Mailing Address - Country:US
Mailing Address - Phone:215-592-0255
Mailing Address - Fax:
Practice Address - Street 1:46 N 10TH ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3005
Practice Address - Country:US
Practice Address - Phone:215-592-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000052171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty