Provider Demographics
NPI:1831497965
Name:SINO-LEGACY ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:SINO-LEGACY ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FRACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-984-2455
Mailing Address - Street 1:46164 WARM SPRINGS BLVD
Mailing Address - Street 2:UNIT 266
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7985
Mailing Address - Country:US
Mailing Address - Phone:510-623-8787
Mailing Address - Fax:510-623-8788
Practice Address - Street 1:46164 WARM SPRINGS BLVD
Practice Address - Street 2:UNIT 266
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7985
Practice Address - Country:US
Practice Address - Phone:510-623-8787
Practice Address - Fax:510-623-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27826111N00000X
CADC0278260111N00000X
CADC18679111NI0013X
CAAC11584171100000X
CAAC0066920171100000X
CAAC6692171100000X
CAAC13796171100000X
CAAC2765171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty