Provider Demographics
NPI:1538568845
Name:ABUNDANT HEAVEN TRADITIONAL CHINESE MEDICINE
Entity type:Organization
Organization Name:ABUNDANT HEAVEN TRADITIONAL CHINESE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESE-GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:408-628-1888
Mailing Address - Street 1:621 E CAMPBELL AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2126
Mailing Address - Country:US
Mailing Address - Phone:408-628-1888
Mailing Address - Fax:408-724-8999
Practice Address - Street 1:621 E CAMPBELL AVE STE 8
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2126
Practice Address - Country:US
Practice Address - Phone:408-628-1888
Practice Address - Fax:408-724-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78623YOtherBLUE SHIELD OF CALIFORNIA PIN