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General NPI Number Information
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NPI Number | 1922502004
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Entity Type | Organization
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Legal Business Name | SIMI ACUPUNCTURE INC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 1433 W MERCED AVE STE 324
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City | WEST COVINA
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State | CA
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Zip | 91790
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Country | US
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Telephone | 626-960-8877
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Fax | 877-315-3777
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Provider Business Mailing Address
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Address Line | 1433 W MERCED AVE STE 324
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City | WEST COVINA
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State | CA
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Zip | 91790-3419
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Country | US
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Telephone | 626-960-8877
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Fax | 877-315-3777
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Authorized Official
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Title or Position | CEO
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Name | SANG SOO PARK
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Credential | L.AC
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Telephone | 626-960-8877
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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 | AC15605
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License Number State | CA
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