Provider Demographics
NPI:1639258502
Name:LEWELLING ACUPUNCTURE CTR
Entity Type:Organization
Organization Name:LEWELLING ACUPUNCTURE CTR
Other - Org Name:HESPERIAN ACUPUNCTURE CTR
Other - Org Type:Other Name
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:WAN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:510-278-3250
Mailing Address - Street 1:888 E LEWELLING BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-1108
Mailing Address - Country:US
Mailing Address - Phone:510-278-3250
Mailing Address - Fax:510-481-7788
Practice Address - Street 1:888 E LEWELLING BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-1108
Practice Address - Country:US
Practice Address - Phone:510-278-3250
Practice Address - Fax:510-481-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0004750171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty