Provider Demographics
NPI:1891006466
Name:BELLEVUE ACUPUNCTURE CLINIC INC
Entity Type:Organization
Organization Name:BELLEVUE ACUPUNCTURE CLINIC INC
Other - Org Name:BELLEVUE ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:CHANGFU
Authorized Official - Last Name:JIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-443-7992
Mailing Address - Street 1:14021 NE 8TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4134
Mailing Address - Country:US
Mailing Address - Phone:425-746-8589
Mailing Address - Fax:425-746-9686
Practice Address - Street 1:14021 NE 8TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4134
Practice Address - Country:US
Practice Address - Phone:425-746-8589
Practice Address - Fax:425-746-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000168171100000X
WAAC60064453171100000X
173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty