Provider Demographics
NPI:1710733100
Name:MAHJONG ACUPUNCTURE AND TRADITIONAL CHINESE MEDICINE, INC.
Entity type:Organization
Organization Name:MAHJONG ACUPUNCTURE AND TRADITIONAL CHINESE MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAI
Authorized Official - Suffix:
Authorized Official - Credentials:DTCM, LAC
Authorized Official - Phone:669-588-4567
Mailing Address - Street 1:550 E WEDDELL DR UNIT 4202
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-2373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1399 S WINCHESTER BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4342
Practice Address - Country:US
Practice Address - Phone:408-261-0766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty