=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558454884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAEWON HEALING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3440 WILSHIRE BLVD STE 542
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-427-9790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27628 BEECHWOOD DR
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91351-3466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-571-6604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JI YOUNG PARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-571-6604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC10633
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------