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General NPI Number Information
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NPI Number | 1861907784
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Entity Type | Organization
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Legal Business Name | MODERN MEDIAL ALTERNATIVE
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 18232 GALE AVE
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91748
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Country | US
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Telephone | 626-242-7695
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Fax | 626-964-2659
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Provider Business Mailing Address
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Address Line | P.O. BOX 90851
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91715
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Country | US
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Telephone | 626-242-7695
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Fax | 626-964-2659
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Authorized Official
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Title or Position | OWNER
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Name | CHIA BING DU
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Credential | PH.D L AC.
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Telephone | 626-242-7695
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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 |
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License Number State |
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