Provider Demographics
NPI:1629525589
Name:GOLDEN BLOSSOM BODYWORKS
Entity Type:Organization
Organization Name:GOLDEN BLOSSOM BODYWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-843-5624
Mailing Address - Street 1:8 WINDLE PARK
Mailing Address - Street 2:APT 2
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3911
Mailing Address - Country:US
Mailing Address - Phone:914-843-5624
Mailing Address - Fax:
Practice Address - Street 1:8 WINDLE PARK
Practice Address - Street 2:APT 2
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3911
Practice Address - Country:US
Practice Address - Phone:914-843-5624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0264171225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty