Provider Demographics
NPI:1073197299
Name:EASTERN ALTERNATIVE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:EASTERN ALTERNATIVE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IL JU
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:949-533-8084
Mailing Address - Street 1:2804 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6211
Mailing Address - Country:US
Mailing Address - Phone:949-533-8084
Mailing Address - Fax:
Practice Address - Street 1:2804 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6211
Practice Address - Country:US
Practice Address - Phone:949-533-8084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty