Provider Demographics
NPI:1487146122
Name:WAI ACUPUNCTURE & INTEGRATIVE CHINESE MEDICINE LLC
Entity type:Organization
Organization Name:WAI ACUPUNCTURE & INTEGRATIVE CHINESE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-917-1000
Mailing Address - Street 1:2612 VERDE LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2901 WEST S.R. 434
Practice Address - Street 2:SUITE 141
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779
Practice Address - Country:US
Practice Address - Phone:407-917-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty