Provider Demographics
NPI:1770931917
Name:THRIVE ACUPUNCTURE GROUP, INC.
Entity type:Organization
Organization Name:THRIVE ACUPUNCTURE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:408-541-0188
Mailing Address - Street 1:1137 TASMAN DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-2228
Mailing Address - Country:US
Mailing Address - Phone:408-541-0188
Mailing Address - Fax:
Practice Address - Street 1:1137 TASMAN DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-2228
Practice Address - Country:US
Practice Address - Phone:408-541-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15794305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization