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General NPI Number Information
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NPI Number | 1366992877
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Entity Type | Organization
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Legal Business Name | PRO CARE PAIN CLINIC
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 621 S VIRGIL AVE STE 310
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City | LOS ANGELES
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State | CA
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Zip | 90005-4047
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Country | US
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Telephone | 213-487-1025
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Fax | 888-450-1242
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Provider Business Mailing Address
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Address Line | 621 S VIRGIL AVE STE 310
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City | LOS ANGELES
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State | CA
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Zip | 90005-4047
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Country | US
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Telephone | 213-487-1025
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MYONGSEOK SONG
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Credential |
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Telephone | 213-487-1025
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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 | AC16014
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License Number State | CA
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