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General NPI Number Information
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NPI Number | 1801396726
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Entity Type | Organization
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Legal Business Name | DIVINITY ACUPUNCTURE
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 3314 MOTOR AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-3712
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Country | US
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Telephone | 424-341-2408
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Fax |
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Provider Business Mailing Address
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Address Line | 2908 ALSACE AVE APT 3
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City | LOS ANGELES
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State | CA
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Zip | 90016-3426
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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 | BRYANNA SUN
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Credential | L.AC.
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Telephone | 424-341-2408
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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 | AC17586
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License Number State | CA
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