Provider Demographics
NPI:1154777829
Name:TONG SHIN ACUPUNCTURE & HERBS CENTER
Entity type:Organization
Organization Name:TONG SHIN ACUPUNCTURE & HERBS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DIPLOM(NCCAOM)
Authorized Official - Phone:708-359-1184
Mailing Address - Street 1:5816 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1225
Mailing Address - Country:US
Mailing Address - Phone:708-359-1184
Mailing Address - Fax:
Practice Address - Street 1:5816 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-1225
Practice Address - Country:US
Practice Address - Phone:708-359-1184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty