Provider Demographics
NPI:1639306632
Name:EVERGREEN ACUPUNCTURE & CHINESE HERBS, LLC
Entity Type:Organization
Organization Name:EVERGREEN ACUPUNCTURE & CHINESE HERBS, LLC
Other - Org Name:E.A.C.H.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:XIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-215-1683
Mailing Address - Street 1:3375 SCOTT BLVD
Mailing Address - Street 2:SUITE 332
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-3110
Mailing Address - Country:US
Mailing Address - Phone:408-215-1683
Mailing Address - Fax:408-773-6238
Practice Address - Street 1:3375 SCOTT BLVD
Practice Address - Street 2:SUITE 332
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3110
Practice Address - Country:US
Practice Address - Phone:408-215-1683
Practice Address - Fax:408-773-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12136171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty