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General NPI Number Information
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NPI Number | 1831508571
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE MASTER CLINIC LLC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 2705 S DIAMOND BAR BLVD STE 208
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3554
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Country | US
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Telephone | 909-833-1138
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 S DIAMOND BAR BLVD STE 208
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3554
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Country | US
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Telephone | 909-833-1138
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GEORGE H KU
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Credential | ACU
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Telephone | 909-833-1138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | AC 11602
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License Number State | CA
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