Provider Demographics
NPI:1518228337
Name:MIRAE ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:MIRAE ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC.
Authorized Official - Prefix:
Authorized Official - First Name:MINKYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-336-8998
Mailing Address - Street 1:4980 BARRANCA PKWY #130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8645
Mailing Address - Country:US
Mailing Address - Phone:949-336-8998
Mailing Address - Fax:949-336-8558
Practice Address - Street 1:4980 BARRANCA PKWY #130
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8645
Practice Address - Country:US
Practice Address - Phone:949-336-8998
Practice Address - Fax:949-336-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13371171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC13371OtherACUPUNCTURE