Provider Demographics
NPI:1306229711
Name:TONGBU WELLNESS CENTER,LLC
Entity type:Organization
Organization Name:TONGBU WELLNESS CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-895-5871
Mailing Address - Street 1:1682 NOVATO BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-7000
Mailing Address - Country:US
Mailing Address - Phone:415-895-5871
Mailing Address - Fax:415-895-6389
Practice Address - Street 1:1682 NOVATO BLVD
Practice Address - Street 2:SUITE 152
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-7000
Practice Address - Country:US
Practice Address - Phone:415-895-5871
Practice Address - Fax:415-895-6389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty