Provider Demographics
NPI:1083968044
Name:GRACE ACUPUNCTURE HEALTH CENTER INC.
Entity Type:Organization
Organization Name:GRACE ACUPUNCTURE HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:YUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-529-3115
Mailing Address - Street 1:2727 WALSH AVE.,
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051
Mailing Address - Country:US
Mailing Address - Phone:408-748-1168
Mailing Address - Fax:
Practice Address - Street 1:2727 WALSH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0956
Practice Address - Country:US
Practice Address - Phone:408-748-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12190261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health