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General NPI Number Information
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NPI Number | 1730615915
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Entity Type | Organization
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Legal Business Name | ENERGY BODY ACUPUNCTURE INC.
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 116 E BROADWAY SUITE 203
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City | GLENDALE
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State | CA
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Zip | 91205-1000
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Country | US
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Telephone | 818-437-8583
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Fax |
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Provider Business Mailing Address
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Address Line | 116 E BROADWAY SUITE 203
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City | GLENDALE
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State | CA
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Zip | 91205-1000
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Country | US
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Telephone | 818-437-8583
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KUANG- CHEN YANG
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Credential | LICENSE ACUPUNCTURE
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Telephone | 818-437-8583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | AC9818
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License Number State | CA
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