=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720710783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAVE Q ACUPUNCTURE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2022
-----------------------------------------------------
Last Update Date | 06/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3861 MISSION AVE STE B27
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92058-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-970-0244
-----------------------------------------------------
Fax | 760-696-3882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3861 MISSION AVE STE B27
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92058-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-970-0244
-----------------------------------------------------
Fax | 760-696-3882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUCPUNCTURIST/OWNER
-----------------------------------------------------
Name | MISS MIJOUNG CHOI
-----------------------------------------------------
Credential | DAOM
-----------------------------------------------------
Telephone | 760-970-0244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------