Provider Demographics
NPI:1104237031
Name:INTENTIONAL HEALTH, AN ACUPUNCTURE AND HOLISTIC HEALING CORP.
Entity type:Organization
Organization Name:INTENTIONAL HEALTH, AN ACUPUNCTURE AND HOLISTIC HEALING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIEN-CHUNG
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:650-648-3558
Mailing Address - Street 1:505 ANITA LN
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1604
Mailing Address - Country:US
Mailing Address - Phone:650-648-3558
Mailing Address - Fax:
Practice Address - Street 1:1828 EL CAMINO REAL
Practice Address - Street 2:#401
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3103
Practice Address - Country:US
Practice Address - Phone:650-648-3558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15713171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty