Provider Demographics
NPI:1376219808
Name:SPRINGLIGHT ST.MARY'S ACUPUNCTURE AND HERBS, INC.
Entity type:Organization
Organization Name:SPRINGLIGHT ST.MARY'S ACUPUNCTURE AND HERBS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:CHONGHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:408-966-5871
Mailing Address - Street 1:1603 FLOWER GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-6413
Mailing Address - Country:US
Mailing Address - Phone:408-966-5871
Mailing Address - Fax:
Practice Address - Street 1:6055 MERIDIAN AVE STE 30
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2700
Practice Address - Country:US
Practice Address - Phone:408-966-5871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service