=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811309842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APRICOT GROVE ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2014
-----------------------------------------------------
Last Update Date | 06/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2920 F ST SUITE F 11
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-434-3415
-----------------------------------------------------
Fax | 888-498-7692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2920 F ST SUITE F 11
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-434-3415
-----------------------------------------------------
Fax | 888-498-7692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | EUN J PARK
-----------------------------------------------------
Credential | L. AC.
-----------------------------------------------------
Telephone | 661-434-3415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 13318
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 11521
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------