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General NPI Number Information
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NPI Number | 1356746325
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Entity Type | Organization
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Legal Business Name | IC ORIENTAL CLINIC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 1327 E KATELLA AVE
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City | ORANGE
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State | CA
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Zip | 92867
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Country | US
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Telephone | 714-771-3127
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Fax | 714-406-2817
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Provider Business Mailing Address
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Address Line | 1327 E KATELLA AVE
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City | ORANGE
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State | CA
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Zip | 92867
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Country | US
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Telephone | 714-771-3127
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Fax | 714-406-2817
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | SEON HO SONG
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Credential | L.AC
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Telephone | 714-771-3127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC15886
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License Number State | CA
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