Healthcare Provider Details

I. General information

NPI: 1366088718
Provider Name (Legal Business Name): EASTERN ACUPUNCTURE & MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9655 MONTE VISTA AVE STE 408
MONTCLAIR CA
91763-2238
US

IV. Provider business mailing address

9655 MONTE VISTA AVE STE 408
MONTCLAIR CA
91763-2238
US

V. Phone/Fax

Practice location:
  • Phone: 909-621-2179
  • Fax: 909-621-2175
Mailing address:
  • Phone: 626-300-0885
  • Fax: 626-300-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NI MEI
Title or Position: PRESIDENT / CEO
Credential: AC
Phone: 909-621-2179