Provider Demographics
NPI:1881042059
Name:SPECIALIZED ACUPUNCTURE & HERBAL MEDICINE CLINIC LLC
Entity Type:Organization
Organization Name:SPECIALIZED ACUPUNCTURE & HERBAL MEDICINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUNHUI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, LAC
Authorized Official - Phone:203-979-6828
Mailing Address - Street 1:9 CANNER ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2601
Mailing Address - Country:US
Mailing Address - Phone:203-979-6828
Mailing Address - Fax:
Practice Address - Street 1:61 ARROW RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1357
Practice Address - Country:US
Practice Address - Phone:203-979-6828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-29
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTACUPUNCTURIST 000444302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization