Provider Demographics
NPI:1184022832
Name:CHOICE ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:CHOICE ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-778-0875
Mailing Address - Street 1:25004 BLUE RAVINE RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25004 BLUE RAVINE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5283
Practice Address - Country:US
Practice Address - Phone:916-778-0875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11924171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty