Provider Demographics
NPI:1609121490
Name:ANANDA ACUPUNCTURE GROUP, INC.
Entity Type:Organization
Organization Name:ANANDA ACUPUNCTURE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG GIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-760-1033
Mailing Address - Street 1:1161 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3112
Mailing Address - Country:US
Mailing Address - Phone:213-760-1033
Mailing Address - Fax:877-234-2675
Practice Address - Street 1:1161 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3112
Practice Address - Country:US
Practice Address - Phone:213-760-1033
Practice Address - Fax:877-234-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty