Provider Demographics
NPI:1174010094
Name:CUPERTINO HOLISTIC HEALING CLINIC,INC
Entity Type:Organization
Organization Name:CUPERTINO HOLISTIC HEALING CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:XIAODAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:650-766-9718
Mailing Address - Street 1:20445 PACIFICA DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3017
Mailing Address - Country:US
Mailing Address - Phone:650-766-8718
Mailing Address - Fax:
Practice Address - Street 1:20445 PACIFICA DR UNIT 1
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3017
Practice Address - Country:US
Practice Address - Phone:650-766-8718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13263261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center