Provider Demographics
NPI:1598117566
Name:MIRACLE PAINCARE ACUPUNCTURE INC
Entity Type:Organization
Organization Name:MIRACLE PAINCARE ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-392-0104
Mailing Address - Street 1:15508 S NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4014
Mailing Address - Country:US
Mailing Address - Phone:310-523-3747
Mailing Address - Fax:310-323-6470
Practice Address - Street 1:15508 S NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4014
Practice Address - Country:US
Practice Address - Phone:310-523-3747
Practice Address - Fax:310-323-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6544171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty