1477628444 NPI number — MR. SHI XUE ZHAO CERTIFIED ACUPUNCTUR

Table of content: MR. SHI XUE ZHAO CERTIFIED ACUPUNCTUR (NPI 1477628444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477628444 NPI number — MR. SHI XUE ZHAO CERTIFIED ACUPUNCTUR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZHAO
Provider First Name:
SHI
Provider Middle Name:
XUE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED ACUPUNCTUR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZHAO
Provider Other First Name:
STEPHEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CERTIFIED ACUPUNCTUR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477628444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1564 MONTGOMERY HWY
Provider Second Line Business Mailing Address:
UNIT E
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35216-4532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-822-5552
Provider Business Mailing Address Fax Number:
205-822-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1564 MONTGOMERY HWY
Provider Second Line Business Practice Location Address:
UNIT E
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-822-5552
Provider Business Practice Location Address Fax Number:
205-822-5552
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  005786 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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