Provider Demographics
NPI:1720565666
Name:PROFESSIONAL ACUPUNCTURE CLINIC PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL ACUPUNCTURE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:XIAOYING
Authorized Official - Middle Name:
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:L AC MAOM
Authorized Official - Phone:832-770-0686
Mailing Address - Street 1:4214 S PINE BROOK CV
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3261
Mailing Address - Country:US
Mailing Address - Phone:832-770-0686
Mailing Address - Fax:
Practice Address - Street 1:1101 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2039
Practice Address - Country:US
Practice Address - Phone:832-770-0686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty