MEDICARE: 66 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

General Provider Information

NPI Number	:	1821561804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	66 ACUPUNCTURE & HERBS, INC.

Provider Business Mailing Address
First Line	:	17595 ALMAHURST ST STE 230
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91748-1799
Country	:	US
Telephone Number	:	626-839-5697
Fax Number	:	626-839-5697

Provider Business Practice Location Address
First Line	:	17595 ALMAHURST ST STE 230
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91748-1799
Country	:	US
Telephone Number	:	626-839-5697
Fax Number	:	626-839-5697

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	BOB WANG
Credential	:	L.AC.
Telephone Number	:	626-839-5697

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	01/02/2019

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