Provider Demographics
NPI:1134637663
Name:CRANE& TURTLE ACUPUNCTURE
Entity Type:Organization
Organization Name:CRANE& TURTLE ACUPUNCTURE
Other - Org Name:CRANE & TURTLE ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER& PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUNGSOO
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-894-8785
Mailing Address - Street 1:474 SAVONA WAY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-4841
Mailing Address - Country:US
Mailing Address - Phone:310-894-8785
Mailing Address - Fax:
Practice Address - Street 1:28501 CANWOOD ST STE 3C
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3206
Practice Address - Country:US
Practice Address - Phone:310-894-8785
Practice Address - Fax:323-433-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16976171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty