Provider Demographics
NPI:1326598806
Name:EAST WEST NATURAL MEDICINE CENTER
Entity Type:Organization
Organization Name:EAST WEST NATURAL MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-543-8958
Mailing Address - Street 1:1415 HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2915
Mailing Address - Country:US
Mailing Address - Phone:805-543-8958
Mailing Address - Fax:805-543-4403
Practice Address - Street 1:1415 HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2915
Practice Address - Country:US
Practice Address - Phone:805-543-8958
Practice Address - Fax:805-543-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3174305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization