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General NPI Number Information
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NPI Number | 1639258502
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Entity Type | Organization
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Legal Business Name | LEWELLING ACUPUNCTURE CTR
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 888 E LEWELLING BLVD
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City | HAYWARD
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State | CA
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Zip | 94541-1108
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Country | US
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Telephone | 510-278-3250
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Fax | 510-481-7788
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Provider Business Mailing Address
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Address Line | 888 E LEWELLING BLVD
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City | HAYWARD
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State | CA
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Zip | 94541-1108
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Country | US
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Telephone | 510-278-3250
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Fax | 510-481-7788
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | DR. JONG WAN KIM
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Credential | OMD
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Telephone | 510-278-3250
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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 | AC0004750
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License Number State | CA
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