1497199277 NPI number — ATLANTIC INSTITUTE OF ORIENTAL MEDICINE

Table of content: (NPI 1497199277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497199277 NPI number — ATLANTIC INSTITUTE OF ORIENTAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC INSTITUTE OF ORIENTAL MEDICINE
Provider Last Name:
Provider First Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1497199277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E BROWARD BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33301-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-763-9840
Provider Business Mailing Address Fax Number:
954-763-9844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E BROWARD BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33301-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-763-9840
Provider Business Practice Location Address Fax Number:
954-763-9844
Provider Enumeration Date:
04/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
YEN
Authorized Official First Name:
JOHANNA
Authorized Official Middle Name:
CHU
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-763-9844

Provider Taxonomy Codes

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

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





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