Provider Demographics
NPI:1053059253
Name:IRVINE GREEN ACUPUNCTURE INC
Entity Type:Organization
Organization Name:IRVINE GREEN ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOUNGNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-751-9901
Mailing Address - Street 1:4850 BARRANCA PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4747
Mailing Address - Country:US
Mailing Address - Phone:949-751-9901
Mailing Address - Fax:
Practice Address - Street 1:4850 BARRANCA PKWY STE 205
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4747
Practice Address - Country:US
Practice Address - Phone:949-751-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty