MEDICARE: MBR ACUPUNCTURE & HERB, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1083236814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBR ACUPUNCTURE & HERB, INC.

Provider Business Mailing Address
First Line	:	8303 CLAIREMONT MESA BLVD STE 104
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1326
Country	:	US
Telephone Number	:	858-866-6081
Fax Number	:	858-715-3990

Provider Business Practice Location Address
First Line	:	8303 CLAIREMONT MESA BLVD STE 104
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1326
Country	:	US
Telephone Number	:	858-866-6081
Fax Number	:	858-715-3990

Authorized Official
Title or Position	:	CEO
Name	:	KYU OK CHO
Credential	:	L.AC.
Telephone Number	:	858-866-6081

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	05/14/2020

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