Provider Demographics
NPI:1558805275
Name:FAMILY CHOICE ACUPUNCTURE
Entity Type:Organization
Organization Name:FAMILY CHOICE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:YOL
Authorized Official - Last Name:PYO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:760-870-4181
Mailing Address - Street 1:16785 BEAR VALLEY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1423
Mailing Address - Country:US
Mailing Address - Phone:760-870-4181
Mailing Address - Fax:760-646-8037
Practice Address - Street 1:16785 BEAR VALLEY RD STE 4
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1423
Practice Address - Country:US
Practice Address - Phone:760-870-4181
Practice Address - Fax:760-646-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7406261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20444Medicare UPIN