Provider Demographics
NPI:1386208908
Name:CLASSICAL ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:CLASSICAL ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:DINARI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-473-2090
Mailing Address - Street 1:1554 S SEPULVEDA BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3359
Mailing Address - Country:US
Mailing Address - Phone:310-473-2090
Mailing Address - Fax:
Practice Address - Street 1:1554 S SEPULVEDA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3359
Practice Address - Country:US
Practice Address - Phone:310-473-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730386624OtherNPI