Healthcare Provider Details

I. General information

NPI: 1538832258
Provider Name (Legal Business Name): A&C WELLPOINT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 W 6TH ST STE 617
LOS ANGELES CA
90020-2553
US

IV. Provider business mailing address

PO BOX 2895
GARDENA CA
90247-1095
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-8008
  • Fax: 213-388-7941
Mailing address:
  • Phone: 310-532-8008
  • Fax: 213-388-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MI OK KIM
Title or Position: ACUPUNCTURIST
Credential: L.AC
Phone: 310-532-8008