Healthcare Provider Details

I. General information

NPI: 1497696280
Provider Name (Legal Business Name): EXPERIENCE ACUPUNCTURE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N MONTEBELLO BLVD
MONTEBELLO CA
90640-3630
US

IV. Provider business mailing address

524 N MONTEBELLO BLVD
MONTEBELLO CA
90640-3630
US

V. Phone/Fax

Practice location:
  • Phone: 626-493-9960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHIH CHANG CHAO
Title or Position: DIRECTOR
Credential: MR
Phone: 626-493-9960