MEDICARE: ACUJOA 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	171100000X	Acupuncturist	AC 12094	CA

General Provider Information

NPI Number	:	1952703324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUJOA ACUPUNCTURE, INC

Provider Business Mailing Address
First Line	:	421 N BROOKHURST ST STE 106
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-5618
Country	:	US
Telephone Number	:	714-292-7988
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 N BROOKHURST ST STE 106
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-5618
Country	:	US
Telephone Number	:	714-292-7988
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JI SEON HONG
Credential	:
Telephone Number	:	714-292-7988

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/17/2014

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