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General NPI Number Information
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NPI Number | 1376179085
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Entity Type | Organization
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Legal Business Name | RAPHAEL ACUPUNCTURE
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Dates
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Enumeration Date | 03/14/2020
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 3030 W OLYMPIC BLVD STE 204
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City | LOS ANGELES
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State | CA
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Zip | 90006-6505
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Country | US
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Telephone | 213-407-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 W OLYMPIC BLVD STE 204
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City | LOS ANGELES
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State | CA
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Zip | 90006-6505
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Country | US
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Telephone | 213-407-6900
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KWANG SOO SUK
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Credential | ACUPUNCTURE
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Telephone | 213-407-6900
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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 |
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License Number State |
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