Provider Demographics
NPI:1164707055
Name:OLIVE TREE ORIENTAL MEDICINE, INC.
Entity Type:Organization
Organization Name:OLIVE TREE ORIENTAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EUN HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:213-382-2003
Mailing Address - Street 1:711 S VERMONT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1587
Mailing Address - Country:US
Mailing Address - Phone:213-382-2003
Mailing Address - Fax:
Practice Address - Street 1:711 S VERMONT AVE STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1587
Practice Address - Country:US
Practice Address - Phone:213-382-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC00011211171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty