Provider Demographics
NPI:1962961532
Name:MA'S ACUPUNCTURE & CHINESE MEDICINE AT BELLEVUE, INC
Entity type:Organization
Organization Name:MA'S ACUPUNCTURE & CHINESE MEDICINE AT BELLEVUE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-502-9256
Mailing Address - Street 1:1540 140TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4579
Mailing Address - Country:US
Mailing Address - Phone:425-502-9256
Mailing Address - Fax:
Practice Address - Street 1:1540 140TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4579
Practice Address - Country:US
Practice Address - Phone:425-502-9256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00000000000OtherACUPUNCTURIST