MEDICARE: DAN B ACUPUNCTURE 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	261Q00000X	Clinic/Center	AC12466	CA

General Provider Information

NPI Number	:	1487935466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAN B ACUPUNCTURE INC

Provider Business Mailing Address
First Line	:	12792 VALLEY VIEW ST STE D
Second Line	:	12792 VALLEY VIEW ST STE D
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2509
Country	:	US
Telephone Number	:	714-366-3062
Fax Number	:	714-898-2589

Provider Business Practice Location Address
First Line	:	12792 VALLEY VIEW ST STE D
Second Line	:	12792 VALLEY VIEW ST STE D
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2509
Country	:	US
Telephone Number	:	714-366-3062
Fax Number	:	714-898-2589

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	JINWOO PARK
Credential	:	L.AC
Telephone Number	:	714-366-3062

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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