Provider Demographics
NPI:1033284575
Name:EVERGREEN NATURAL MEDICINE AND ACUPUNCTURE CORP.
Entity Type:Organization
Organization Name:EVERGREEN NATURAL MEDICINE AND ACUPUNCTURE CORP.
Other - Org Name:ACUPUNCTURE AND NATURAL MEDICINE CLINIC OF GLENDORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:XIN
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:626-963-6878
Mailing Address - Street 1:102 W ROUTE 66 STE D
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6247
Mailing Address - Country:US
Mailing Address - Phone:626-963-6878
Mailing Address - Fax:626-963-6881
Practice Address - Street 1:102 W ROUTE 66 STE D
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6247
Practice Address - Country:US
Practice Address - Phone:626-963-6878
Practice Address - Fax:626-963-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4171171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty