Provider Demographics
NPI:1427440601
Name:BAMBOO WISDOM ACUPUNCTURE
Entity type:Organization
Organization Name:BAMBOO WISDOM ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KAN
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MAOM
Authorized Official - Phone:781-235-1038
Mailing Address - Street 1:572 WASHINGTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6418
Mailing Address - Country:US
Mailing Address - Phone:781-235-1038
Mailing Address - Fax:
Practice Address - Street 1:572 WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6418
Practice Address - Country:US
Practice Address - Phone:781-235-1038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty