Provider Demographics
NPI:1083159701
Name:ANCIENT ASIA ACUPUNCTURE
Entity Type:Organization
Organization Name:ANCIENT ASIA ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-261-1777
Mailing Address - Street 1:1607 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-3983
Mailing Address - Country:US
Mailing Address - Phone:408-261-1777
Mailing Address - Fax:408-261-1111
Practice Address - Street 1:1607 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-3983
Practice Address - Country:US
Practice Address - Phone:408-261-1777
Practice Address - Fax:408-261-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6620171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty