Provider Demographics
NPI:1114159126
Name:EUGENE ENTERPRISE, INC
Entity Type:Organization
Organization Name:EUGENE ENTERPRISE, INC
Other - Org Name:ALL NATURAL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN KYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:714-628-0047
Mailing Address - Street 1:665 N TUSTIN ST STE Y
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7148
Mailing Address - Country:US
Mailing Address - Phone:714-628-0047
Mailing Address - Fax:714-628-0061
Practice Address - Street 1:665 N TUSTIN ST STE Y
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7148
Practice Address - Country:US
Practice Address - Phone:714-628-0047
Practice Address - Fax:714-628-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11911171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225202732OtherNPPES