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General NPI Number Information
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NPI Number | 1063957439
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Entity Type | Organization
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Legal Business Name | SEO ACUPUNCTURE & HERB CLINIC, INC.
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 2775 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-2632
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Country | US
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Telephone | 213-822-2330
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Fax |
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Provider Business Mailing Address
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Address Line | 2775 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-2632
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAUL SEO
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Credential |
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Telephone | 213-822-2330
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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 | AC5185
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License Number State | CA
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