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General NPI Number Information
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NPI Number | 1801304621
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Entity Type | Organization
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Legal Business Name | ID ACUPUNCTURE
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 13851 E 14TH ST STE 203
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2627
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Country | US
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Telephone | 510-895-8912
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Fax | 510-895-8930
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Provider Business Mailing Address
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Address Line | 13851 E 14TH ST STE 203
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2627
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Country | US
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Telephone | 510-895-8912
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Fax | 510-895-8930
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Authorized Official
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Title or Position | OWNER
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Name | MR. BYOUNG WOOK MIN
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Credential | L.AC.
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Telephone | 510-895-8912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number | AC16564
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License Number State | CA
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