Provider Demographics
NPI:1255407235
Name:INSTITUTE FOR TRADITIONAL ACUPUNCTURE AND HERBOLOGY
Entity type:Organization
Organization Name:INSTITUTE FOR TRADITIONAL ACUPUNCTURE AND HERBOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:ND, OMD, LAC
Authorized Official - Phone:415-924-2910
Mailing Address - Street 1:21 TAMAL VISTA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1130
Mailing Address - Country:US
Mailing Address - Phone:415-924-2910
Mailing Address - Fax:415-924-5072
Practice Address - Street 1:21 TAMAL VISTA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1130
Practice Address - Country:US
Practice Address - Phone:415-924-2910
Practice Address - Fax:415-924-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 970171100000X
CAAC 4943171100000X
CAG62455207R00000X
CAAC 10122171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty