=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629424668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2016
-----------------------------------------------------
Last Update Date | 05/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 LONG BEACH BLVD
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90802-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-436-8881
-----------------------------------------------------
Fax | 562-436-8886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 LONG BEACH BLVD
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90802-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-436-8881
-----------------------------------------------------
Fax | 562-436-8886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | HAE YANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-436-8881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC10765
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------