Provider Demographics
NPI:1427421148
Name:RENEW WELLNESS ACUPUNCTURE
Entity type:Organization
Organization Name:RENEW WELLNESS ACUPUNCTURE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-254-5267
Mailing Address - Street 1:2301 SUNSET BLVD
Mailing Address - Street 2:1309
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4372
Mailing Address - Country:US
Mailing Address - Phone:415-254-5267
Mailing Address - Fax:
Practice Address - Street 1:5714 LONETREE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3734
Practice Address - Country:US
Practice Address - Phone:415-254-5267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty