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General NPI Number Information
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NPI Number | 1821319690
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Entity Type | Organization
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Legal Business Name | GREEN WELLNESS CENTER, INC
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 342 E GOLF RD
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City | ARLINGTON HTS
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State | IL
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Zip | 60005-4008
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Country | US
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Telephone | 847-427-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 342 E GOLF RD
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City | ARLINGTON HTS
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State | IL
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Zip | 60005-4008
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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 | ACUPUNCTURIST
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Name | HYUN SOOK KIM
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Credential |
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Telephone | 847-971-5129
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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 | 198000739
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License Number State | IL
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