Provider Demographics
NPI:1679970412
Name:PHOENIX HEALTH CARE
Entity Type:Organization
Organization Name:PHOENIX HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/HERBALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-707-3030
Mailing Address - Street 1:580 E JULIAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3313
Mailing Address - Country:US
Mailing Address - Phone:408-707-3030
Mailing Address - Fax:
Practice Address - Street 1:1754 TECHNOLOGY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1308
Practice Address - Country:US
Practice Address - Phone:408-707-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16212171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty