MEDICARE: GUASHA RESEARCH INSTITUTE CORP.

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	AC13374	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC12589	OTHER	CA	ACUPUNCTURE
2	AC13374	OTHER	CA	ACUPUNCTURE

General Provider Information

NPI Number	:	1174854723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUASHA RESEARCH INSTITUTE CORP.

Provider Business Mailing Address
First Line	:	3242 W 8TH ST
Second Line	:	101
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-2176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3242 W 8TH ST
Second Line	:	101
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-2176
Country	:	US
Telephone Number	:	213-272-6939
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KYUNGSUB SONG
Credential	:
Telephone Number	:	213-272-6939

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	06/09/2011

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