Healthcare Provider Details

I. General information

NPI: 1487203493
Provider Name (Legal Business Name): FAT TIGER ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 WILSHIRE BLVD STE 701
LOS ANGELES CA
90048-5509
US

IV. Provider business mailing address

6404 WILSHIRE BLVD STE 701
LOS ANGELES CA
90048-5509
US

V. Phone/Fax

Practice location:
  • Phone: 323-852-9704
  • Fax:
Mailing address:
  • Phone: 323-852-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACOB S COHEN
Title or Position: OWNER
Credential: L.AC.
Phone: 323-852-9722