Provider Demographics
NPI:1326479858
Name:EUDEMONIA MEDICAL SERVICE
Entity Type:Organization
Organization Name:EUDEMONIA MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:408-641-1004
Mailing Address - Street 1:1851 MCCARTHY BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7448
Mailing Address - Country:US
Mailing Address - Phone:408-641-1004
Mailing Address - Fax:
Practice Address - Street 1:1851 MCCARTHY BLVD #115
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-641-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
CA05D2040223291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty