Provider Demographics
NPI:1275563660
Name:JIAN-MIN ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:JIAN-MIN ACUPUNCTURE CLINIC
Other - Org Name:JIAN-MIN ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:MR
Authorized Official - First Name:HON
Authorized Official - Middle Name:P
Authorized Official - Last Name:YUE
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:213-680-0746
Mailing Address - Street 1:833 ALPINE STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-6402
Mailing Address - Country:US
Mailing Address - Phone:213-680-0746
Mailing Address - Fax:213-680-1037
Practice Address - Street 1:833 ALPINE STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-6402
Practice Address - Country:US
Practice Address - Phone:213-680-0746
Practice Address - Fax:213-680-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1533171100000X
CAAC0024190171100000X
CA2419171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0024190Medicaid
CAZZZ66116ZOtherBLUE SHIELD OF CALIFORNIA