Provider Demographics
NPI:1972732394
Name:ANTO ACUPUNCTURE & CHINESE MEDICINE CLINIC,INC
Entity type:Organization
Organization Name:ANTO ACUPUNCTURE & CHINESE MEDICINE CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HIDENORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:408-996-7358
Mailing Address - Street 1:P.O. BOX 2003
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95015-2003
Mailing Address - Country:US
Mailing Address - Phone:408-996-7358
Mailing Address - Fax:408-996-7358
Practice Address - Street 1:20445 PACIFICA DR SUITE A 1
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-996-7358
Practice Address - Fax:408-996-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3148329302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization