Provider Demographics
NPI:1851574487
Name:EVERGREEN BIO-TECH INC
Entity Type:Organization
Organization Name:EVERGREEN BIO-TECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TENG FANG
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR ORIENTAL MED
Authorized Official - Phone:480-357-3904
Mailing Address - Street 1:9221 E BASELINE RD
Mailing Address - Street 2:SUITE A109-617
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8310
Mailing Address - Country:US
Mailing Address - Phone:480-357-3904
Mailing Address - Fax:480-357-4639
Practice Address - Street 1:5501 N ORACLE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3829
Practice Address - Country:US
Practice Address - Phone:520-889-9366
Practice Address - Fax:480-357-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0448171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty