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General NPI Number Information
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NPI Number | 1619498979
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Entity Type | Organization
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Legal Business Name | ENDEO USA INC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 6301 BEACH BLVD STE 200
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City | BUENA PARK
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State | CA
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Zip | 90621-4030
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Country | US
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Telephone | 714-522-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 77 HALLMARK
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City | IRVINE
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State | CA
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Zip | 92620-3447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | JEONGBOK NAM
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Credential |
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Telephone | 714-356-5811
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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 |
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License Number State |
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