=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275921454
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WELLNESS ACUPUNCTURE GROUP OF AMERICA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2014
-----------------------------------------------------
Last Update Date | 12/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 W ARTESIA BLVD SUITE 21-22
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90248-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-967-2540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1425 W ARTESIA BLVD SUITE 21-22
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90248-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. UCHENNA ABBA ONYEANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-967-2540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 38MC00678700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------