# KINETIC INNER QI ACUPUNCTURE AND SPORTS MEDICINE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356841431
- **Authorized official:** MIRIAM GILSON L.AC. MSTOM (LICENSED ACUPUNCTURIST)
- **Authorized official phone:** (619) 634-9550

## Contact information

- **Practice address:** 543 ORANGE AVE, CORONADO, CA 92118-1826
- **Practice address phone:** (619) 634-9550
- **Practice address fax:** (619) 437-4909
- **Mailing address:** 543 ORANGE AVE, CORONADO, CA 92118-1826
- **Mailing address phone:** (619) 634-9550
- **Mailing address fax:** (619) 437-4909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | AC13094 | CA | Yes |

## Other

- **Enumeration date:** 02/15/2018
- **Last updated:** 02/15/2018