Healthcare Provider Details

I. General information

NPI: 1366863391
Provider Name (Legal Business Name): FEI JI SR. ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21076 SANDPIPER ST
WALNUT CA
91789-2050
US

IV. Provider business mailing address

21076 SANDPIPER ST
WALNUT CA
91789-2050
US

V. Phone/Fax

Practice location:
  • Phone: 626-922-1855
  • Fax: 626-922-1855
Mailing address:
  • Phone: 626-922-1855
  • Fax: 626-922-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: