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General NPI Number Information
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NPI Number | 1417660796
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Entity Type | Organization
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Legal Business Name | TAE ACUPUNCTURE CORP
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 74399 HIGHWAY 111 STE A
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City | PALM DESERT
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State | CA
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Zip | 92260-4128
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Country | US
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Telephone | 949-812-9457
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Fax |
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Provider Business Mailing Address
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Address Line | 160 BLUE JAY LN
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City | REDLANDS
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State | CA
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Zip | 92374-1651
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TAEHYANG KIM
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Credential | LAC, PHD
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Telephone | 949-812-9457
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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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