=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922397678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHIL'S ACUPUNCTURE CLINIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2011
-----------------------------------------------------
Last Update Date | 04/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14764 BEACH BLVD
-----------------------------------------------------
City | LA MIRADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90638-4250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-523-8000
-----------------------------------------------------
Fax | 714-523-8000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14764 BEACH BLVD
-----------------------------------------------------
City | LA MIRADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90638-4250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-523-8000
-----------------------------------------------------
Fax | 714-523-8000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YEONG HOE HEO
-----------------------------------------------------
Credential | AC
-----------------------------------------------------
Telephone | 714-523-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC10697
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------