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General NPI Number Information
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NPI Number | 1295050862
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Entity Type | Organization
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Legal Business Name | POKE ACUPUNCTURE
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 1810 COURTNEY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90046-2105
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Country | US
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Telephone | 310-489-1772
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Fax |
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Provider Business Mailing Address
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Address Line | 1810 COURTNEY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90046-2105
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Country | US
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Telephone | 310-489-1772
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL ALAN BROWN
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Credential | L.AC.
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Telephone | 310-489-1772
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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 | 12013
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License Number State | CA
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