Provider Demographics
NPI:1164933370
Name:SIWA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SIWA MEDICAL GROUP INC
Other - Org Name:SIWA HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SOOYEOL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-220-4845
Mailing Address - Street 1:1010 WILSHIRE BLVD APT 315
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5664
Mailing Address - Country:US
Mailing Address - Phone:213-220-4845
Mailing Address - Fax:213-785-5166
Practice Address - Street 1:1010 WILSHIRE BLVD APT 315
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5664
Practice Address - Country:US
Practice Address - Phone:213-220-4845
Practice Address - Fax:213-785-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-14
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17443171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty