Provider Demographics
NPI:1114198959
Name:RAPHA ACUPUNCTURE HEALING CENTER INC
Entity Type:Organization
Organization Name:RAPHA ACUPUNCTURE HEALING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUNG SUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-388-1250
Mailing Address - Street 1:1029 1/2 S BERENDO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2603
Mailing Address - Country:US
Mailing Address - Phone:213-388-1250
Mailing Address - Fax:213-388-1350
Practice Address - Street 1:1029 1/2 S BERENDO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2603
Practice Address - Country:US
Practice Address - Phone:213-388-1250
Practice Address - Fax:213-388-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13557171100000X
CAAC 12582171100000X
CAAC 4900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty