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General NPI Number Information
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NPI Number | 1225586530
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Entity Type | Organization
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Legal Business Name | RIVERSIDE ACUPUNCTURE
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 6717 INDIANA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-4263
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Country | US
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Telephone | 951-680-0204
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Fax | 951-680-0085
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Provider Business Mailing Address
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Address Line | 6717 INDIANA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-4263
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Country | US
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Telephone | 213-327-5783
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Fax | 951-680-0085
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | YEONOK KIM
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Credential |
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Telephone | 213-327-5783
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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 | AC10709
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License Number State | CA
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