MEDICARE: FAT TIGER ACUPUNCTURE

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	:	1487203493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAT TIGER ACUPUNCTURE

Provider Business Mailing Address
First Line	:	6404 WILSHIRE BLVD STE 701
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5509
Country	:	US
Telephone Number	:	323-852-9704
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 WILSHIRE BLVD STE 701
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5509
Country	:	US
Telephone Number	:	323-852-9704
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACOB S COHEN
Credential	:	L.AC.
Telephone Number	:	323-852-9722

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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Directions to “FAT TIGER ACUPUNCTURE ” Practice Location

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