Provider Demographics
NPI:1891348652
Name:IVY ACUPUNCTURE & MEDICINE CLINIC
Entity Type:Organization
Organization Name:IVY ACUPUNCTURE & MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIFENG
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-897-4836
Mailing Address - Street 1:1330 CORAL WAY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2945
Mailing Address - Country:US
Mailing Address - Phone:786-897-4836
Mailing Address - Fax:786-319-4086
Practice Address - Street 1:1330 CORAL WAY
Practice Address - Street 2:SUITE 308
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2945
Practice Address - Country:US
Practice Address - Phone:786-897-4836
Practice Address - Fax:786-319-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty