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General NPI Number Information
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NPI Number | 1033550371
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Entity Type | Organization
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Legal Business Name | MAC ORIENTAL MEDICINE CLINIC INC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 4009 WILSHIRE BLVD STE 200C
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City | LOS ANGELES
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State | CA
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Zip | 90010-3407
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Country | US
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Telephone | 213-514-2877
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Fax |
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Provider Business Mailing Address
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Address Line | 4009 WILSHIRE BLVD STE 200C
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City | LOS ANGELES
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State | CA
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Zip | 90010-3407
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Country | US
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Telephone | 213-514-2877
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Fax |
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Authorized Official
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Title or Position | SECRATARY
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Name | MR. KWANG HOON AN
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Credential |
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Telephone | 213-245-8704
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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 | 14345
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License Number State | CA
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