Healthcare Provider Details

I. General information

NPI: 1902404247
Provider Name (Legal Business Name): ARBOL ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 FOOTHILL BLVD STE A
LA CRESCENTA CA
91214-4509
US

IV. Provider business mailing address

2620 FOOTHILL BLVD STE A
LA CRESCENTA CA
91214-4509
US

V. Phone/Fax

Practice location:
  • Phone: 213-909-4035
  • Fax:
Mailing address:
  • Phone: 213-909-4035
  • 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: JEONG HOON KIM
Title or Position: C.E.O.
Credential: L.AC.
Phone: 213-909-4035