Provider Demographics
NPI:1851583306
Name:ACUPUNTURE TREATMENT CENTER
Entity Type:Organization
Organization Name:ACUPUNTURE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-484-4532
Mailing Address - Street 1:19267 COLIMA RD STE F
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HGTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3007
Mailing Address - Country:US
Mailing Address - Phone:310-484-4532
Mailing Address - Fax:
Practice Address - Street 1:924 DOVERFIELD AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1240
Practice Address - Country:US
Practice Address - Phone:310-484-4532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COGAC000130Medicaid