Provider Demographics
NPI:1538650478
Name:HIDDEN DRAGON HEALING, INC.
Entity Type:Organization
Organization Name:HIDDEN DRAGON HEALING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENNIESE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:OMD LAC
Authorized Official - Phone:954-681-3100
Mailing Address - Street 1:182 E WILBUR AVE UNIT 45
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3226
Mailing Address - Country:US
Mailing Address - Phone:954-681-3100
Mailing Address - Fax:
Practice Address - Street 1:160 INTERNATIONAL PKWY STE 250-8
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5056
Practice Address - Country:US
Practice Address - Phone:954-681-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-26
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3938261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care