=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497927156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING AND IMAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2008
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 998 S ROBERTSON BLVD SUITE 205
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90035-1637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-854-5994
-----------------------------------------------------
Fax | 310-854-5967
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 998 S ROBERTSON BLVD SUITE 205
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90035-1637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-854-5994
-----------------------------------------------------
Fax | 310-854-5967
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. JONG HI BAE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-854-5994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 11024
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------