Provider Demographics
NPI:1689796625
Name:AMERICAN ACADEMY OF TRADITIONAL CHINESE MEDICINE, INC.
Entity Type:Organization
Organization Name:AMERICAN ACADEMY OF TRADITIONAL CHINESE MEDICINE, INC.
Other - Org Name:AMERICAN ACADEMY OF ACUPUNCTURE AND ORIENTAL MEDICINE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:651-631-0204
Mailing Address - Street 1:1925 COUNTY ROAD B2 W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2703
Mailing Address - Country:US
Mailing Address - Phone:651-631-0204
Mailing Address - Fax:651-631-0361
Practice Address - Street 1:1925 COUNTY ROAD B2 W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2703
Practice Address - Country:US
Practice Address - Phone:651-631-0204
Practice Address - Fax:651-631-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty