Provider Demographics
NPI:1275659245
Name:YICAWELL ACUPUNCTURE AND HERBAL CENTER INC.
Entity Type:Organization
Organization Name:YICAWELL ACUPUNCTURE AND HERBAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-242-4968
Mailing Address - Street 1:10311 S DE ANZA BLVD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3028
Mailing Address - Country:US
Mailing Address - Phone:408-252-1863
Mailing Address - Fax:
Practice Address - Street 1:10311 S DE ANZA BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3028
Practice Address - Country:US
Practice Address - Phone:408-252-1863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10293171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty