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General NPI Number Information
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NPI Number | 1285028027
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Entity Type | Organization
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Legal Business Name | SELF HEALING ACUPUNCTURE & HERB
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 4410 W UNION HILLS DR # A8
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City | GLENDALE
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State | AZ
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Zip | 85308-1660
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Country | US
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Telephone | 623-266-0103
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Fax |
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Provider Business Mailing Address
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Address Line | 4410 W UNION HILLS DR # A8
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City | GLENDALE
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State | AZ
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Zip | 85308-1660
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Country | US
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Telephone | 623-266-0103
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Fax |
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Authorized Official
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Title or Position | MSOM
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Name | ANDREW BOSUN KIM
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Credential | LAC
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Telephone | 623-266-0103
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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 | 0948
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License Number State | AZ
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