Healthcare Provider Details

I. General information

NPI: 1932739430
Provider Name (Legal Business Name): GRD ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 S LA CIENEGA BLVD STE 330
BEVERLY HILLS CA
90211-3358
US

IV. Provider business mailing address

292 S LA CIENEGA BLVD STE 330
BEVERLY HILLS CA
90211-3358
US

V. Phone/Fax

Practice location:
  • Phone: 323-936-0521
  • Fax:
Mailing address:
  • Phone: 323-936-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHLA GURU DEV KHALSA
Title or Position: OWNER
Credential: L.AC.
Phone: 323-936-0521