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General NPI Number Information
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NPI Number | 1750528451
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Entity Type | Organization
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Legal Business Name | GREEN ACUPUNCTURE, INC.
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 112 W 9TH ST STE 1126
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City | LOS ANGELES
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State | CA
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Zip | 90015-1569
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Country | US
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Telephone | 213-493-1401
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Fax | 213-403-5608
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Provider Business Mailing Address
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Address Line | 112 W 9TH ST STE 1126
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City | LOS ANGELES
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State | CA
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Zip | 90015-1569
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Country | US
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Telephone | 213-493-1401
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Fax | 213-403-5608
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Authorized Official
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Title or Position | CEO
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Name | MR. JAEWOO YOU
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Credential | L.AC.
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Telephone | 213-493-1401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC12608
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License Number State | CA
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