MEDICARE: JADE SPRINGS ACUPUNCTURE & HERBS, 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	15738	CA

General Provider Information

NPI Number	:	1598184038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JADE SPRINGS ACUPUNCTURE & HERBS, INC.

Provider Business Mailing Address
First Line	:	916 15TH ST APT 2
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-3147
Country	:	US
Telephone Number	:	424-248-9767
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 W OLYMPIC BLVD STE 636
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1525
Country	:	US
Telephone Number	:	424-248-9767
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JANET CHUNG
Credential	:	L.AC., DIPL.O.M.
Telephone Number	:	424-248-9767

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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