Provider Demographics
NPI:1326242413
Name:ACUPUNCTURE & HERBOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:ACUPUNCTURE & HERBOLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAN QIU
Authorized Official - Middle Name:
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:OMD, LAC
Authorized Official - Phone:310-866-3911
Mailing Address - Street 1:1112 MONTANA AVE
Mailing Address - Street 2:SUITE #628
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1652
Mailing Address - Country:US
Mailing Address - Phone:310-866-3911
Mailing Address - Fax:
Practice Address - Street 1:1530 LINCOLN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2741
Practice Address - Country:US
Practice Address - Phone:310-866-3911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10671171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty