Provider Demographics
NPI:1285028027
Name:SELF HEALING ACUPUNCTURE & HERB
Entity Type:Organization
Organization Name:SELF HEALING ACUPUNCTURE & HERB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSOM
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BOSUN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:623-266-0103
Mailing Address - Street 1:4410 W UNION HILLS DR # A8
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1660
Mailing Address - Country:US
Mailing Address - Phone:623-266-0103
Mailing Address - Fax:
Practice Address - Street 1:4410 W UNION HILLS DR # A8
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1660
Practice Address - Country:US
Practice Address - Phone:623-266-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty