Provider Demographics
NPI:1265806483
Name:NW CLINIC
Entity type:Organization
Organization Name:NW CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-968-8665
Mailing Address - Street 1:257 CASTRO ST STE 223
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1287
Mailing Address - Country:US
Mailing Address - Phone:650-968-8665
Mailing Address - Fax:650-968-6286
Practice Address - Street 1:2060 WALSH AVE STE 101
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2568
Practice Address - Country:US
Practice Address - Phone:650-968-8665
Practice Address - Fax:650-968-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-26
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16540171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty