Healthcare Provider Details

I. General information

NPI: 1013473503
Provider Name (Legal Business Name): NEW HEAVEN ACUPUNCTURE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 LAUREL CANYON BLVD STE A
STUDIO CITY CA
91604-3711
US

IV. Provider business mailing address

3959 LAUREL CANYON BLVD STE A
STUDIO CITY CA
91604-3711
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-7979
  • Fax: 818-980-7980
Mailing address:
  • Phone: 818-980-7979
  • Fax: 818-980-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANG WOO KO
Title or Position: ACUPUNCTURIST
Credential:
Phone: 818-980-7979