Provider Demographics
NPI:1861050791
Name:FIVE BRANCHES ACUPUNCTURE INC
Entity type:Organization
Organization Name:FIVE BRANCHES ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:415-726-8355
Mailing Address - Street 1:5 BON AIR RD STE 221
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1136
Mailing Address - Country:US
Mailing Address - Phone:415-726-8355
Mailing Address - Fax:
Practice Address - Street 1:5 BON AIR RD STE 221
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1136
Practice Address - Country:US
Practice Address - Phone:415-726-8355
Practice Address - Fax:415-634-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942772090Medicaid
CA1851636617Medicaid