Healthcare Provider Details

I. General information

NPI: 1982457891
Provider Name (Legal Business Name): EAST-WESTERN MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 S WESTERN AVE STE 207
LOS ANGELES CA
90006-2376
US

IV. Provider business mailing address

1144 S WESTERN AVE STE 207
LOS ANGELES CA
90006-2376
US

V. Phone/Fax

Practice location:
  • Phone: 310-935-8703
  • Fax: 213-722-5025
Mailing address:
  • Phone: 310-935-8703
  • Fax: 213-722-5025

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: DR. DONG GWON HAN
Title or Position: CEO
Credential: DC, DAOM, LAC
Phone: 310-935-8703