Provider Demographics
NPI:1508684473
Name:EVERGREEN EAST ASIAN MEDICINE LLC
Entity type:Organization
Organization Name:EVERGREEN EAST ASIAN MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DSOM
Authorized Official - Phone:602-653-7272
Mailing Address - Street 1:7025 N 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2517
Mailing Address - Country:US
Mailing Address - Phone:623-243-5195
Mailing Address - Fax:
Practice Address - Street 1:7025 N 57TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2517
Practice Address - Country:US
Practice Address - Phone:623-243-5195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty