=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497077390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST ALLIANCE MEDICAL GROUP INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2010
-----------------------------------------------------
Last Update Date | 02/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 E WALNUT ST SUITE 1
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-1685
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-756-1880
-----------------------------------------------------
Fax | 626-288-0230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 E NORWOOD PL
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91801-5307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-756-1880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHIENFU CHARLIE TSAO
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 626-756-1880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC13190
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------