Provider Demographics
NPI:1568873495
Name:ELIM MEDICAL GROUP
Entity Type:Organization
Organization Name:ELIM MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-329-9968
Mailing Address - Street 1:3350 SCOTT BLVD
Mailing Address - Street 2:BLDG. 58-2
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-3104
Mailing Address - Country:US
Mailing Address - Phone:408-329-9968
Mailing Address - Fax:
Practice Address - Street 1:522 W FREMONT AVE
Practice Address - Street 2:APT. 4
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3200
Practice Address - Country:US
Practice Address - Phone:408-828-3055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16042171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty