Provider Demographics
NPI:1619184074
Name:EAST&WEST MEDICAL CLINIC
Entity Type:Organization
Organization Name:EAST&WEST MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:YUE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:818-889-8988
Mailing Address - Street 1:30313 CANWOOD ST STE 23
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2034
Mailing Address - Country:US
Mailing Address - Phone:818-889-8988
Mailing Address - Fax:818-889-7787
Practice Address - Street 1:30313 CANWOOD #23
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-889-8988
Practice Address - Fax:818-889-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9461171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty