Healthcare Provider Details

I. General information

NPI: 1669910352
Provider Name (Legal Business Name): ACUPUNCTURE AVENUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 N EL MOLINO AVE SUITE 202
PASADENA CA
91101-1687
US

IV. Provider business mailing address

234 N EL MOLINO AVE SUITE 202
PASADENA CA
91101-1687
US

V. Phone/Fax

Practice location:
  • Phone: 626-734-7779
  • Fax:
Mailing address:
  • Phone: 626-734-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13541
License Number StateCA

VIII. Authorized Official

Name: PETER YEUNG
Title or Position: OWNER / ACUPUNCTURIST
Credential: LAC
Phone: 626-660-9541