Healthcare Provider Details

I. General information

NPI: 1538237557
Provider Name (Legal Business Name): BEVERLY HILLS INTEGRATIVE MEDICINE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7414 BEVERLY BLVD
LOS ANGELES CA
90036-2725
US

IV. Provider business mailing address

27 PALMETTO DR APT A
ALHAMBRA CA
91801-5907
US

V. Phone/Fax

Practice location:
  • Phone: 310-989-8668
  • Fax: 323-297-2471
Mailing address:
  • Phone: 310-989-8668
  • Fax: 323-297-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: XIAO L JIANG
Title or Position: CEO
Credential:
Phone: 310-989-8668