=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134663156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOMA CLINIC,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2016
-----------------------------------------------------
Last Update Date | 12/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6301 BEACH BLVD SUITE 111
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90621-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-521-5662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6301 BEACH BLVD SUITE 111
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90621-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-521-5662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. KANG-HYUN CHOI
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 714-521-5662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC7759
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------