=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679051775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCEL ACUPUNCTURE & HEALTH CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2018
-----------------------------------------------------
Last Update Date | 07/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28222 AGOURA RD STE 100
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-404-2425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28222 AGOURA RD STE 100
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-404-2425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ CEO
-----------------------------------------------------
Name | MISS NEGEEN KIARASHI
-----------------------------------------------------
Credential | L.A.C
-----------------------------------------------------
Telephone | 818-404-2425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 17685
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------