MEDICARE: PHIL'S ACUPUNCTURE CLINIC 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	AC10697	CA

General Provider Information

NPI Number	:	1922397678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHIL'S ACUPUNCTURE CLINIC INC.

Provider Business Mailing Address
First Line	:	14764 BEACH BLVD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-4250
Country	:	US
Telephone Number	:	714-523-8000
Fax Number	:	714-523-8000

Provider Business Practice Location Address
First Line	:	14764 BEACH BLVD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-4250
Country	:	US
Telephone Number	:	714-523-8000
Fax Number	:	714-523-8000

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YEONG HOE HEO
Credential	:	AC
Telephone Number	:	714-523-8000

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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