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General NPI Number Information
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NPI Number | 1477875862
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Entity Type | Organization
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Legal Business Name | FANG MAO MEDICAL GROUP
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 760 WASHBURN AVE SUITE # 23
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City | CORONA
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State | CA
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Zip | 92882-3303
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Country | US
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Telephone | 951-582-0999
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Fax | 951-582-0900
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Provider Business Mailing Address
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Address Line | 760 WASHBURN AVE SUITE # 23
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City | CORONA
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State | CA
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Zip | 92882-3303
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Country | US
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Telephone | 951-582-0999
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Fax | 951-582-0900
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Authorized Official
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Title or Position | ACUPUNCTURIST / PRESIDENT
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Name | DR. CHI FANG HSU
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Credential | L.AC., O.M.D.
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Telephone | 951-582-0999
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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 | AC11187
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License Number State | CA
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