=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083236814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MBR ACUPUNCTURE & HERB, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2020
-----------------------------------------------------
Last Update Date | 05/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8303 CLAIREMONT MESA BLVD STE 104
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-866-6081
-----------------------------------------------------
Fax | 858-715-3990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8303 CLAIREMONT MESA BLVD STE 104
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-866-6081
-----------------------------------------------------
Fax | 858-715-3990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KYU OK CHO
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 858-866-6081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------