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General NPI Number Information
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NPI Number | 1609165133
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Entity Type | Organization
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Legal Business Name | AJ ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 601 E YORBA LINDA BLVD #2B
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City | PLACENTIA
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State | CA
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Zip | 92870-3006
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Country | US
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Telephone | 714-312-5460
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Fax |
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Provider Business Mailing Address
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Address Line | 601 E YORBA LINDA BLVD #2B
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City | PLACENTIA
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State | CA
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Zip | 92870-3006
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Country | US
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Telephone | 714-312-5460
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MYUNGSOO MO
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Credential | L.AC., PH.D.,
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Telephone | 909-263-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U01843
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC11989
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License Number State | CA
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