Healthcare Provider Details

I. General information

NPI: 1992545388
Provider Name (Legal Business Name): AYA ACUPUNCTURE & HERBS INC #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR STE 240
BEVERLY HILLS CA
90210-6811
US

IV. Provider business mailing address

415 N CRESCENT DR STE 240
BEVERLY HILLS CA
90210-6811
US

V. Phone/Fax

Practice location:
  • Phone: 626-427-1779
  • Fax: 626-466-3886
Mailing address:
  • Phone: 626-427-1779
  • Fax: 626-466-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JI EUN MIN
Title or Position: CEO
Credential: L.AC.
Phone: 626-427-1779