Provider Demographics
NPI:1316186307
Name:IYASHI WELLNESS
Entity Type:Organization
Organization Name:IYASHI WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LURIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:OZEKI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-770-9560
Mailing Address - Street 1:13075 PACIFIC PROMENADE
Mailing Address - Street 2:#414
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2110
Mailing Address - Country:US
Mailing Address - Phone:310-770-9560
Mailing Address - Fax:
Practice Address - Street 1:11340 W OLYMPIC BLVD
Practice Address - Street 2:STE 356
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1608
Practice Address - Country:US
Practice Address - Phone:310-770-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty