Provider Demographics
NPI:1528559754
Name:MEDSACU
Entity Type:Organization
Organization Name:MEDSACU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE
Authorized Official - Prefix:MR
Authorized Official - First Name:HEE JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-335-1135
Mailing Address - Street 1:6031 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2304
Mailing Address - Country:US
Mailing Address - Phone:714-335-1145
Mailing Address - Fax:
Practice Address - Street 1:6031 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621
Practice Address - Country:US
Practice Address - Phone:714-335-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16826171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16826OtherACUPUNCTURE