Provider Demographics
NPI:1326566332
Name:THE SAGE PLACE: ACUPUNCTURE, HERBAL MEDICINE AND WELLNESS INC.
Entity Type:Organization
Organization Name:THE SAGE PLACE: ACUPUNCTURE, HERBAL MEDICINE AND WELLNESS INC.
Other - Org Name:THE SAGE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUDIN-BAEHRLE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MTCM, MQT
Authorized Official - Phone:510-579-5749
Mailing Address - Street 1:626 JEFFERSON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1726
Mailing Address - Country:US
Mailing Address - Phone:650-503-3357
Mailing Address - Fax:
Practice Address - Street 1:626 JEFFERSON AVE STE 3
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1726
Practice Address - Country:US
Practice Address - Phone:650-503-3357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty