Healthcare Provider Details

I. General information

NPI: 1053668574
Provider Name (Legal Business Name): GUANG GE CUI ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 PARTHENIA ST #N-4
PANORAMA CITY CA
91402-2917
US

IV. Provider business mailing address

14650 PARTHENIA ST #N-4
PANORAMA CITY CA
91402-2917
US

V. Phone/Fax

Practice location:
  • Phone: 213-605-0607
  • Fax:
Mailing address:
  • Phone: 213-605-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: