Provider Demographics
NPI:1427454933
Name:FIRST CHOICE WELLNESS CLINIC
Entity type:Organization
Organization Name:FIRST CHOICE WELLNESS CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-930-1786
Mailing Address - Street 1:3680 STEVENS CREEK BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1205
Mailing Address - Country:US
Mailing Address - Phone:408-930-1786
Mailing Address - Fax:408-260-9963
Practice Address - Street 1:3680 STEVENS CREEK BLVD STE F
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1205
Practice Address - Country:US
Practice Address - Phone:408-930-1786
Practice Address - Fax:408-260-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32832111N00000X
CAAC17435171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty