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General NPI Number Information
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NPI Number | 1750849907
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Entity Type | Organization
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Legal Business Name | PHELAN ACUPUNCTURE & HERBS, INC
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 16209 MAIN ST
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City | HESPERIA
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State | CA
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Zip | 92345-3559
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Country | US
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Telephone | 213-392-2133
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Fax |
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Provider Business Mailing Address
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Address Line | 9375 SHEEP CREEK RD
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City | PHELAN
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State | CA
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Zip | 92371-8586
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRACE JUNG KIM
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Credential |
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Telephone | 213-392-2133
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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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