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General NPI Number Information
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NPI Number | 1487150942
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Entity Type | Organization
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Legal Business Name | SP MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 3130 W OLYMPIC BLVD STE 290
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City | LOS ANGELES
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State | CA
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Zip | 90006-2484
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Country | US
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Telephone | 213-822-2312
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 W OLYMPIC BLVD STE 290
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City | LOS ANGELES
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State | CA
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Zip | 90006-2484
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Country | US
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Telephone | 213-822-2312
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CHI-YUAN SUI
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Credential |
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Telephone | 213-822-2312
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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 | AC14175
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License Number State | CA
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