Provider Demographics
NPI:1558628248
Name:ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:RAMCHANDRA
Authorized Official - Last Name:GHARMALKAR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC,ND
Authorized Official - Phone:714-437-7710
Mailing Address - Street 1:1530 BAKER ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3752
Mailing Address - Country:US
Mailing Address - Phone:714-437-7710
Mailing Address - Fax:
Practice Address - Street 1:1530 BAKER ST
Practice Address - Street 2:SUITE G
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3752
Practice Address - Country:US
Practice Address - Phone:714-437-7710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4473,ND 182302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization