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General NPI Number Information
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NPI Number | 1720159015
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Entity Type | Organization
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Legal Business Name | IVY ACUPUNCTURE & HERBAL HOUSE
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20265 VALLEY BLVD STE E
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City | WALNUT
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State | CA
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Zip | 91789-2655
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Country | US
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Telephone | 909-869-8501
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Fax | 909-869-8401
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Provider Business Mailing Address
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Address Line | 20265 VALLEY BLVD STE E
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City | WALNUT
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State | CA
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Zip | 91789-2655
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Country | US
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Telephone | 909-869-8501
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Fax | 909-869-8401
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. LITEH CHANG
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Credential | L.AC.
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Telephone | 909-869-8501
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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 | 8680
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License Number State | CA
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