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General NPI Number Information
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NPI Number | 1700657145
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Entity Type | Organization
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Legal Business Name | PROVISION ACUPUNCTURE
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1107 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-3112
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Country | US
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Telephone | 818-732-0369
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-3112
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Country | US
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Telephone | 818-732-0369
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HYUNGWON LEE
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Credential | PHD, LAC
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Telephone | 213-725-8915
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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 |
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License Number State |
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