Provider Demographics
NPI:1114196037
Name:HYE JUNG BAE ACUPUNCTURE CLINIC, INC.
Entity Type:Organization
Organization Name:HYE JUNG BAE ACUPUNCTURE CLINIC, INC.
Other - Org Name:CHEONG SHIM ORIENTAL HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WOO KYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-534-0058
Mailing Address - Street 1:2756 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2952
Mailing Address - Country:US
Mailing Address - Phone:310-534-0058
Mailing Address - Fax:
Practice Address - Street 1:2756 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2952
Practice Address - Country:US
Practice Address - Phone:310-534-0058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty