Healthcare Provider Details

I. General information

NPI: 1053672626
Provider Name (Legal Business Name): ACUART CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 S ALAMEDA ST 20
VERNON CA
90058-2010
US

IV. Provider business mailing address

1561 S HIGHLAND AVE H
FULLERTON CA
92832-3390
US

V. Phone/Fax

Practice location:
  • Phone: 888-600-2545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11273
License Number StateCA

VIII. Authorized Official

Name: YUN SOO LEE
Title or Position: PRESIDENT
Credential:
Phone: 888-600-2545