Provider Demographics
NPI:1669002390
Name:ENERGETIC ACUPUNCTURE MEDICAL GROUP
Entity Type:Organization
Organization Name:ENERGETIC ACUPUNCTURE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ICK YOUL
Authorized Official - Middle Name:
Authorized Official - Last Name:EOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-963-5027
Mailing Address - Street 1:417 3/4 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3013
Mailing Address - Country:US
Mailing Address - Phone:323-963-5027
Mailing Address - Fax:323-499-1274
Practice Address - Street 1:417 3/4 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3013
Practice Address - Country:US
Practice Address - Phone:323-963-5027
Practice Address - Fax:323-499-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528444668OtherNPPES