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General NPI Number Information
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NPI Number | 1457795346
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Entity Type | Organization
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Legal Business Name | ACUMEDI HEALTH CLINICS
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 19821 ITASCA ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-5607
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Country | US
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Telephone | 213-505-1071
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Fax |
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Provider Business Mailing Address
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Address Line | 19821 ITASCA ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-5607
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Country | US
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Telephone | 213-505-1071
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SANG JAE LEE
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Credential | LAC.
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Telephone | 213-505-1071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | AC14516
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License Number State | CA
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