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General NPI Number Information
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NPI Number | 1659747772
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Entity Type | Organization
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Legal Business Name | BACKANDNECK ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 2120 W 8TH ST UNIT 310
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City | LOS ANGELES
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State | CA
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Zip | 90057-4019
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Country | US
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Telephone | 213-603-0758
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Fax | 213-388-9608
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Provider Business Mailing Address
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Address Line | 2120 W 8TH ST UNIT 310
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City | LOS ANGELES
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State | CA
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Zip | 90057-4019
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Country | US
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Telephone | 213-603-0758
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Fax | 213-388-9608
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Authorized Official
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Title or Position | OWNER
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Name | DR. BONGJOON CHOI
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Credential |
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Telephone | 213-603-0758
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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 | AC14056
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License Number State | CA
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