Provider Demographics
NPI:1093252801
Name:OCEAN AVENUE ACUPUNCTURE
Entity Type:Organization
Organization Name:OCEAN AVENUE ACUPUNCTURE
Other - Org Name:SATORI ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:561-866-8814
Mailing Address - Street 1:2765 S EVERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8657
Mailing Address - Country:US
Mailing Address - Phone:561-866-8814
Mailing Address - Fax:
Practice Address - Street 1:901 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6811
Practice Address - Country:US
Practice Address - Phone:561-866-8814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AP3064302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization