Provider Demographics
NPI:1679707814
Name:ADVANCED ACUPUNCTURE CLINIC,INC
Entity type:Organization
Organization Name:ADVANCED ACUPUNCTURE CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:MING
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:801-563-8477
Mailing Address - Street 1:1135 E SOUTH UNION AVE STE G1
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2938
Mailing Address - Country:US
Mailing Address - Phone:801-563-8477
Mailing Address - Fax:801-563-8477
Practice Address - Street 1:1135 E SOUTH UNION AVE STE G1
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2938
Practice Address - Country:US
Practice Address - Phone:801-563-8477
Practice Address - Fax:801-563-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376131-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty