Provider Demographics
NPI:1710656772
Name:ZEN ACUPUNCTURE CLINIC LLC
Entity Type:Organization
Organization Name:ZEN ACUPUNCTURE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUDRYAVTSEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-731-4586
Mailing Address - Street 1:644 CHIQUITA AVE FRNT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-2704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 N MILPITAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-2727
Practice Address - Country:US
Practice Address - Phone:669-263-6959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service