Healthcare Provider Details

I. General information

NPI: 1497272223
Provider Name (Legal Business Name): PACIFIC COAST COMMUNITY ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11204 BRADDOCK DR
CULVER CITY CA
90230-4807
US

IV. Provider business mailing address

11204 BRADDOCK DR
CULVER CITY CA
90230-4807
US

V. Phone/Fax

Practice location:
  • Phone: 310-985-0554
  • Fax:
Mailing address:
  • Phone: 310-985-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN KIM
Title or Position: CO-OWNER
Credential: L.AC.
Phone: 310-985-0554