Provider Demographics
NPI:1740843374
Name:GREEN CREEK ACUPUNCTURE,INC
Entity type:Organization
Organization Name:GREEN CREEK ACUPUNCTURE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAODAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-766-8718
Mailing Address - Street 1:19275 SAN MARCOS RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5677
Mailing Address - Country:US
Mailing Address - Phone:650-766-8718
Mailing Address - Fax:866-890-9060
Practice Address - Street 1:20735 STEVENS CREEK BLVD STE D
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2104
Practice Address - Country:US
Practice Address - Phone:650-766-8718
Practice Address - Fax:866-890-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain