Provider Demographics
NPI:1689068983
Name:GST NATURAL HERBS AND ACUPUNCTURE CENTER
Entity Type:Organization
Organization Name:GST NATURAL HERBS AND ACUPUNCTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINCE
Authorized Official - Prefix:
Authorized Official - First Name:KEYI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:786-972-2416
Mailing Address - Street 1:317 NE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2304
Mailing Address - Country:US
Mailing Address - Phone:305-493-4555
Mailing Address - Fax:305-493-4555
Practice Address - Street 1:317 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2304
Practice Address - Country:US
Practice Address - Phone:305-493-4555
Practice Address - Fax:305-493-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP965261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center