Healthcare Provider Details

I. General information

NPI: 1801943022
Provider Name (Legal Business Name): 3 ANGELS HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD SUITE 516
BEVERLY HILLS CA
90211-1788
US

IV. Provider business mailing address

250 N ROBERTSON BLVD SUITE 516
BEVERLY HILLS CA
90211-1788
US

V. Phone/Fax

Practice location:
  • Phone: 310-859-7696
  • Fax: 310-859-7699
Mailing address:
  • Phone: 310-859-7696
  • Fax: 310-859-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12865
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10601
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8225
License Number StateCA

VIII. Authorized Official

Name: DR. EUN JEONG SONG
Title or Position: ACUPUNCTURIST
Credential: PH.D, L.AC.
Phone: 310-859-7696