Healthcare Provider Details

I. General information

NPI: 1740609551
Provider Name (Legal Business Name): OMNIA ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18411 CRENSHAW BLVD SUITE 320
TORRANCE CA
90504-5042
US

IV. Provider business mailing address

18411 CRENSHAW BLVD SUITE 320
TORRANCE CA
90504-5042
US

V. Phone/Fax

Practice location:
  • Phone: 213-268-5337
  • Fax:
Mailing address:
  • Phone: 213-268-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7574
License Number StateCA

VIII. Authorized Official

Name: MR. CHAN HO KIM
Title or Position: PRESIDENT
Credential: L.AC
Phone: 213-268-5337