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General NPI Number Information
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NPI Number | 1619184074
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Entity Type | Organization
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Legal Business Name | EAST&WEST MEDICAL CLINIC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30313 CANWOOD #23
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City | AGOURA HILLS
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State | CA
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Zip | 91301
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Country | US
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Telephone | 818-889-8988
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Fax | 818-889-7787
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Provider Business Mailing Address
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Address Line | 30313 CANWOOD ST STE 23
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City | AGOURA HILLS
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State | CA
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Zip | 91301-2034
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Country | US
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Telephone | 818-889-8988
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Fax | 818-889-7787
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GRACE YUE LEE
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Credential | O.M.D
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Telephone | 818-889-8988
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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 | 9461
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License Number State | CA
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