Provider Demographics
NPI:1528595261
Name:FREEFLOW IMMUNITY ACUPUNCTURE
Entity Type:Organization
Organization Name:FREEFLOW IMMUNITY ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOOMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-343-3017
Mailing Address - Street 1:435 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3043
Mailing Address - Country:US
Mailing Address - Phone:310-343-3017
Mailing Address - Fax:562-222-2842
Practice Address - Street 1:435 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3043
Practice Address - Country:US
Practice Address - Phone:310-343-3017
Practice Address - Fax:562-222-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11446171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11446OtherACUPUNCTURIST