Provider Demographics
NPI:1497279731
Name:KENNESAW ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:KENNESAW ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIUYING
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:678-920-0778
Mailing Address - Street 1:1815 OLD 41 HWY NW STE 140
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4422
Mailing Address - Country:US
Mailing Address - Phone:678-402-5170
Mailing Address - Fax:
Practice Address - Street 1:1815 OLD 41 HWY NW STE 140
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4422
Practice Address - Country:US
Practice Address - Phone:678-402-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA191261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center