Provider Demographics
NPI:1669967584
Name:MDT ACUPUNCTURE & TCM CORP
Entity type:Organization
Organization Name:MDT ACUPUNCTURE & TCM CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:XIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-993-8058
Mailing Address - Street 1:2942 E CHAPMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3745
Mailing Address - Country:US
Mailing Address - Phone:714-771-3366
Mailing Address - Fax:714-771-2011
Practice Address - Street 1:2942 E CHAPMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3745
Practice Address - Country:US
Practice Address - Phone:714-771-3366
Practice Address - Fax:714-771-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16101171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16101OtherACUPUNCTURE BOARD