=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528570074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST & WEST ACUPUNCTURE CLINIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2017
-----------------------------------------------------
Last Update Date | 10/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30313 CANWOOD ST STE 23
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-889-8988
-----------------------------------------------------
Fax | 818-889-7787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30313 CANWOOD ST STE 23
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-889-8988
-----------------------------------------------------
Fax | 818-889-7787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HYONGOAK DU
-----------------------------------------------------
Credential | LAC.
-----------------------------------------------------
Telephone | 818-889-8988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC8586
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------