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General NPI Number Information
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NPI Number | 1003062217
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Entity Type | Organization
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Legal Business Name | ST. THERESA ACUPUNCTURE CLINIC INC.
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 13821 SAN ANTONIO DR
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City | NORWALK
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State | CA
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Zip | 90650-4034
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Country | US
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Telephone | 562-484-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 13821 SAN ANTONIO DR
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City | NORWALK
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State | CA
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Zip | 90650-4034
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Country | US
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Telephone | 562-484-0640
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHIN GANG
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Credential | L.AC
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Telephone | 562-484-0640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | L.AC 11560
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License Number State | CA
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