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General NPI Number Information
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NPI Number | 1588060289
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Entity Type | Organization
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Legal Business Name | IMPERIAL CLINIC
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 2527 PACIFIC COAST HWY
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City | TORRANCE
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State | CA
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Zip | 90505-7035
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Country | US
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Telephone | 310-539-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 2527 PACIFIC COAST HWY
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City | TORRANCE
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State | CA
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Zip | 90505-7035
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Country | US
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Telephone | 310-539-2285
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUNGWON HAN
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Credential |
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Telephone | 310-539-2285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC 32639
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License Number State | CA
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