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General NPI Number Information
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NPI Number | 1801386602
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Entity Type | Organization
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Legal Business Name | MEDI&G, INC
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 11441 HEACOCK ST STE E
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City | MORENO VALLEY
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State | CA
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Zip | 92557-7907
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Country | US
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Telephone | 951-505-8126
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Fax | 951-800-8187
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Provider Business Mailing Address
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Address Line | 11441 HEACOCK ST STE E
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City | MORENO VALLEY
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State | CA
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Zip | 92557-7907
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Country | US
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Telephone | 951-505-8126
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MIN JEONG
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Credential |
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Telephone | 951-505-8126
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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 | AC14472
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License Number State | CA
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