Provider Demographics
NPI:1619588811
Name:TPN MODACU1, LLC
Entity Type:Organization
Organization Name:TPN MODACU1, LLC
Other - Org Name:MODERN ACUPUNCTURE KINGWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRANCHISE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THAI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-298-7425
Mailing Address - Street 1:4151 SOUTHWEST FWY STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7413
Mailing Address - Country:US
Mailing Address - Phone:832-930-3569
Mailing Address - Fax:
Practice Address - Street 1:4529 KINGWOOD DR STE 170
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-2630
Practice Address - Country:US
Practice Address - Phone:281-502-8598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty