Provider Demographics
NPI:1407132483
Name:DO ORIENTAL MEDICAL GROUP
Entity type:Organization
Organization Name:DO ORIENTAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SUE JING
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:AC
Authorized Official - Phone:408-399-9888
Mailing Address - Street 1:430 MONTEREY AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5323
Mailing Address - Country:US
Mailing Address - Phone:408-399-9888
Mailing Address - Fax:408-399-9888
Practice Address - Street 1:430 MONTEREY AVE STE 1B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5323
Practice Address - Country:US
Practice Address - Phone:408-399-9888
Practice Address - Fax:408-399-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14157302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization