Provider Demographics
NPI:1700230091
Name:HEALTHY QI ACUPUNCTURE CORP.
Entity Type:Organization
Organization Name:HEALTHY QI ACUPUNCTURE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ARASH
Authorized Official - Last Name:BOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-980-2207
Mailing Address - Street 1:501 PACIFIC STREET
Mailing Address - Street 2:APT. 206
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2477
Mailing Address - Country:US
Mailing Address - Phone:310-980-2207
Mailing Address - Fax:
Practice Address - Street 1:2001 SOUTH BARRINGTON AVENUE
Practice Address - Street 2:SUITE 114
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5337
Practice Address - Country:US
Practice Address - Phone:310-980-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12305171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty