Provider Demographics
NPI:1225362239
Name:JASMINE HERB AND ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:JASMINE HERB AND ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAE CHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-382-0577
Mailing Address - Street 1:3545 WILSHIRE BL.
Mailing Address - Street 2:#337
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2388
Mailing Address - Country:US
Mailing Address - Phone:213-382-0577
Mailing Address - Fax:213-382-0551
Practice Address - Street 1:3545 WILSHIRE BL.
Practice Address - Street 2:#337
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2388
Practice Address - Country:US
Practice Address - Phone:213-382-0577
Practice Address - Fax:213-382-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC10209OtherACUPUNCTURE