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General NPI Number Information
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NPI Number | 1902082928
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Entity Type | Organization
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Legal Business Name | EASTAO CORP.
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 9602 BASELINE RD
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City | ALTA LOMA
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State | CA
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Zip | 91701-5035
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Country | US
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Telephone | 909-989-7000
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Fax | 909-989-7000
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Provider Business Mailing Address
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Address Line | 9602 BASELINE RD
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City | ALTA LOMA
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State | CA
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Zip | 91701-5035
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Country | US
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Telephone | 909-989-7000
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Fax | 909-989-7000
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SAHNG JAE YOO
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Credential | L.AC.
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Telephone | 909-989-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 10000
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License Number State | CA
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