Provider Demographics
NPI:1164889861
Name:TAI WELLNESS GROUP
Entity Type:Organization
Organization Name:TAI WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTRIST
Authorized Official - Prefix:
Authorized Official - First Name:KUEIKU
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-466-5364
Mailing Address - Street 1:221 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2717
Mailing Address - Country:US
Mailing Address - Phone:626-466-5364
Mailing Address - Fax:626-578-1619
Practice Address - Street 1:221 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2717
Practice Address - Country:US
Practice Address - Phone:626-466-5364
Practice Address - Fax:626-578-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16237302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization