Provider Demographics
NPI:1184291072
Name:FA DA YI WANG ACUPUNCTURE CENTER INC
Entity type:Organization
Organization Name:FA DA YI WANG ACUPUNCTURE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHU LI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-438-5668
Mailing Address - Street 1:369 MONACO AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3714
Mailing Address - Country:US
Mailing Address - Phone:408-438-5668
Mailing Address - Fax:510-573-0959
Practice Address - Street 1:43480 MISSION BLVD UNIT 250
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5892
Practice Address - Country:US
Practice Address - Phone:408-438-5668
Practice Address - Fax:510-507-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty