Provider Demographics
NPI:1740609551
Name:OMNIA ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:OMNIA ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:HO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-268-5337
Mailing Address - Street 1:18411 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5042
Mailing Address - Country:US
Mailing Address - Phone:213-268-5337
Mailing Address - Fax:
Practice Address - Street 1:18411 CRENSHAW BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5042
Practice Address - Country:US
Practice Address - Phone:213-268-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7574171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty