Healthcare Provider Details

I. General information

NPI: 1063584969
Provider Name (Legal Business Name): MAY B MOK CA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 S GLENDORA AVE #D
W COVINA CA
91790
US

IV. Provider business mailing address

1043 S GLENDORA AVE #D
W COVINA CA
91790
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-6877
  • Fax: 626-960-6877
Mailing address:
  • Phone: 626-960-6877
  • Fax: 626-960-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: