=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538379482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H AND M ACUPUNCTURE CLINIC,APROFESSIONAL MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 08/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6400 CANOGA AVE 333
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-274-4423
-----------------------------------------------------
Fax | 818-703-9125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20841 VENTURA BLVD 170
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-523-8896
-----------------------------------------------------
Fax | 818-703-9125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUCTURIST
-----------------------------------------------------
Name | MS. HOMA HAMIDI
-----------------------------------------------------
Credential | L.AC
-----------------------------------------------------
Telephone | 818-523-8896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 8966
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------