Provider Demographics
NPI:1760693113
Name:WESTERN AND EASTERN MEDICAL PRACTICE CENTER
Entity Type:Organization
Organization Name:WESTERN AND EASTERN MEDICAL PRACTICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP LAC PRESIDENT OF THE ORGANIZATI
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUN TING
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP MSN LAC PHD
Authorized Official - Phone:415-564-8022
Mailing Address - Street 1:2568 NORIEGA STREET SUITE 203# SF CA 94122 4166
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4166
Mailing Address - Country:US
Mailing Address - Phone:415-564-8022
Mailing Address - Fax:415-564-1996
Practice Address - Street 1:2568 NORIEGA STREET SUITE 203#
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4166
Practice Address - Country:US
Practice Address - Phone:415-564-8022
Practice Address - Fax:415-564-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8803171100000X
CAA38420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336205327OtherNPI TYPE 1