Provider Demographics
NPI:1174715676
Name:SHENNONG ORIENTAL HEALING CENTER
Entity type:Organization
Organization Name:SHENNONG ORIENTAL HEALING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DING
Authorized Official - Middle Name:
Authorized Official - Last Name:GU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:215-627-2220
Mailing Address - Street 1:926 ARCH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3107
Mailing Address - Country:US
Mailing Address - Phone:215-627-2220
Mailing Address - Fax:
Practice Address - Street 1:926 ARCH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3107
Practice Address - Country:US
Practice Address - Phone:215-627-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000433L171100000X
PAAK000696171100000X
PAAK000279L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty