Provider Demographics
NPI:1982092599
Name:CHINESE MEDICINE CENTER
Entity Type:Organization
Organization Name:CHINESE MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CHIA CHI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-667-3298
Mailing Address - Street 1:37200 MEADOWBROOK CMN
Mailing Address - Street 2:APT 105
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3677
Mailing Address - Country:US
Mailing Address - Phone:408-667-3298
Mailing Address - Fax:
Practice Address - Street 1:37982 FREMONT BLVD
Practice Address - Street 2:APT 105
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5029
Practice Address - Country:US
Practice Address - Phone:408-667-3298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-14592261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service