Provider Demographics
NPI:1558492207
Name:ACUPEDIC ACUPUNCTURE GROUP, INC.
Entity Type:Organization
Organization Name:ACUPEDIC ACUPUNCTURE GROUP, INC.
Other - Org Name:ACUPEDICS ACUPUNCTURE GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:YIN-REN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-506-0485
Mailing Address - Street 1:12660 RIVERSIDE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3404
Mailing Address - Country:US
Mailing Address - Phone:818-506-0485
Mailing Address - Fax:818-506-3889
Practice Address - Street 1:12660 RIVERSIDE DR STE 325
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3404
Practice Address - Country:US
Practice Address - Phone:818-506-0485
Practice Address - Fax:818-506-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9772 AND AC8557171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC9772OtherCA ACUPUNCTURE LICENSE
CAAC 8557OtherCA ACUPUNCTURE LICENSE