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NPI Code Detail

MEDICARE: ACUPEDIC ACUPUNCTURE GROUP, INC.

MEDICARE: ACUPEDIC ACUPUNCTURE GROUP, 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
1171100000XAcupuncturistAC9772 AND AC8557CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AC9772OTHERCACA ACUPUNCTURE LICENSE
2AC 8557OTHERCACA ACUPUNCTURE LICENSE

General Provider Information

NPI Number : 1558492207
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACUPEDIC ACUPUNCTURE GROUP, INC.
Provider Business Mailing Address
First Line : 12660 RIVERSIDE DR STE 325
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-3404
Country : US
Telephone Number : 818-506-0485
Fax Number : 818-506-3889
Provider Business Practice Location Address
First Line : 12660 RIVERSIDE DR STE 325
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-3404
Country : US
Telephone Number : 818-506-0485
Fax Number : 818-506-3889
Authorized Official
Title or Position : PRESIDENT
Name : MR. ERIC YIN-REN LEE
Credential : L.AC.
Telephone Number : 818-506-0485
Provider Enumeration Date : 03/07/2007
Last Update Date : 06/13/2008

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