Provider Demographics
NPI:1942538376
Name:ADVANCED EASTERN ACUPUNCTURE & HERB, INC.
Entity Type:Organization
Organization Name:ADVANCED EASTERN ACUPUNCTURE & HERB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAI
Authorized Official - Middle Name:KYUE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-670-9332
Mailing Address - Street 1:14832 BEACH BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4200
Mailing Address - Country:US
Mailing Address - Phone:714-670-9332
Mailing Address - Fax:714-677-1660
Practice Address - Street 1:14832 BEACH BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4200
Practice Address - Country:US
Practice Address - Phone:714-670-9332
Practice Address - Fax:714-677-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12495171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty