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General NPI Number Information
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NPI Number | 1649533043
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Entity Type | Organization
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Legal Business Name | CIRCLE ORIENTAL MEDICINE CLINIC INC
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 3053 W OLYMPIC BLVD STE 311
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City | LOS ANGELES
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State | CA
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Zip | 90006-2558
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Country | US
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Telephone | 213-384-4589
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Fax | 714-906-9182
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Provider Business Mailing Address
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Address Line | 3053 W OLYMPIC BLVD STE 311
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City | LOS ANGELES
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State | CA
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Zip | 90006-2558
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Country | US
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Telephone | 213-384-4589
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Fax | 714-906-9182
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHAN SU PARK
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Credential | AC
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Telephone | 213-384-4589
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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 | AC12191
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License Number State | CA
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