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General NPI Number Information
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NPI Number | 1962956557
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Entity Type | Organization
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Legal Business Name | IMAGO WELLNESS ACUPUNCTURE, INC
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 96 W VILLA ST
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City | PASADENA
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State | CA
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Zip | 91103-3343
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Country | US
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Telephone | 626-399-7572
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Fax |
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Provider Business Mailing Address
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Address Line | 9721 ARDENDALE AVE
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City | ARCADIA
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State | CA
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Zip | 91007-7824
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | PEI-JEN CHU
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Credential |
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Telephone | 626-399-7572
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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 | 16816
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License Number State | CA
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