Healthcare Provider Details

I. General information

NPI: 1417242561
Provider Name (Legal Business Name): POLIN TOGI L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 SAN GABRIEL BLVD STE 200
ROSEMEAD CA
91770-5204
US

IV. Provider business mailing address

601 BEVERLY DR
ARCADIA CA
91006-5430
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-9968
  • Fax:
Mailing address:
  • Phone: 626-574-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 14112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: