Provider Demographics
NPI:1558807529
Name:EVERGLORY ACUPUNCTURE CLINIC & INSTITUTE INC
Entity Type:Organization
Organization Name:EVERGLORY ACUPUNCTURE CLINIC & INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AI PING
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-280-9268
Mailing Address - Street 1:9143 VALLEY BLVD #201B
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1919
Mailing Address - Country:US
Mailing Address - Phone:626-280-9268
Mailing Address - Fax:
Practice Address - Street 1:9143 VALLEY BLVD STE 201B
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1992
Practice Address - Country:US
Practice Address - Phone:626-280-9268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty