Provider Demographics
NPI:1750536488
Name:SHANG CLINC FLORIDA SUN MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:SHANG CLINC FLORIDA SUN MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HE
Authorized Official - Suffix:
Authorized Official - Credentials:AP, LAC, CMD
Authorized Official - Phone:305-662-5585
Mailing Address - Street 1:6902 N KENDALL DR
Mailing Address - Street 2:E303
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1575
Mailing Address - Country:US
Mailing Address - Phone:305-662-5585
Mailing Address - Fax:
Practice Address - Street 1:706 S DIXIE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2601
Practice Address - Country:US
Practice Address - Phone:305-662-5585
Practice Address - Fax:305-665-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP663171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty