Healthcare Provider Details

I. General information

NPI: 1063548857
Provider Name (Legal Business Name): PK ACUPUNCTURE PROFESSIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18031 HIGHWAY 18 SUITE F
APPLE VALLEY CA
92307-2152
US

IV. Provider business mailing address

18031 HIGHWAY 18 SUITE F
APPLE VALLEY CA
92307-2152
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-3255
  • Fax: 760-242-3552
Mailing address:
  • Phone: 760-242-3255
  • Fax: 760-242-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7406
License Number StateCA

VIII. Authorized Official

Name: CHUNG YOL PYO
Title or Position: PRESIDENT OWNER
Credential: ACUPUNCTURIST
Phone: 760-242-3255