Provider Demographics
NPI:1174859037
Name:SAMRA ACUPUNCTURE SPINAL CENTER, INC.
Entity Type:Organization
Organization Name:SAMRA ACUPUNCTURE SPINAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYUG
Authorized Official - Middle Name:YONG
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-384-1100
Mailing Address - Street 1:1730 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1019
Mailing Address - Country:US
Mailing Address - Phone:213-384-1100
Mailing Address - Fax:213-384-1101
Practice Address - Street 1:1730 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1019
Practice Address - Country:US
Practice Address - Phone:213-384-1100
Practice Address - Fax:213-384-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30810111N00000X
CAAC10230171100000X
CAAC12392171100000X
CAAC9503171100000X
CAAC12839171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12839OtherCA ACUPUNCTURE LICENSE
CAAC9503OtherCA ACUPUNCTURE LICENSE
CADC30810OtherCA CHIROPRACTIC LICENSE
CAAC10230OtherCA ACUPUNCTURE LICENSE
CAAC12392OtherCA ACUPUNCTURE LICENSE