Healthcare Provider Details

I. General information

NPI: 1962956557
Provider Name (Legal Business Name): IMAGO WELLNESS ACUPUNCTURE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 W VILLA ST
PASADENA CA
91103-3343
US

IV. Provider business mailing address

9721 ARDENDALE AVE
ARCADIA CA
91007-7824
US

V. Phone/Fax

Practice location:
  • Phone: 626-399-7572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16816
License Number StateCA

VIII. Authorized Official

Name: PEI-JEN CHU
Title or Position: LICENSED ACUPUNCTURIST
Credential:
Phone: 626-399-7572