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General NPI Number Information
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NPI Number | 1265620926
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Entity Type | Organization
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Legal Business Name | 10 BODY TYPE ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 5770 MELROSE AVE STE 207
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City | LOS ANGELES
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State | CA
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Zip | 90038-3873
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Country | US
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Telephone | 213-675-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 5770 MELROSE AVE STE 207
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City | LOS ANGELES
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State | CA
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Zip | 90038-3873
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Country | US
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Telephone | 213-675-0111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEVIN K. CHOE
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Credential | L.AC.
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Telephone | 213-675-0111
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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 | AC 9328
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License Number State | CA
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