Provider Demographics
NPI:1194276436
Name:PERSIMMON HEALTH CENTER, INC.
Entity type:Organization
Organization Name:PERSIMMON HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, L.AC.
Authorized Official - Prefix:
Authorized Official - First Name:YONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-955-0805
Mailing Address - Street 1:3845 PETERSBURG CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3830
Mailing Address - Country:US
Mailing Address - Phone:209-955-0805
Mailing Address - Fax:209-800-8823
Practice Address - Street 1:1625 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6473
Practice Address - Country:US
Practice Address - Phone:209-955-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11287171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty