Provider Demographics
NPI: | 1942667001 |
---|---|
Name: | SUN ACUPUNCTURE GROUP, INC |
Entity Type: | Organization |
Organization Name: | SUN ACUPUNCTURE GROUP, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUNNAM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KIM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LAC |
Authorized Official - Phone: | 714-696-1099 |
Mailing Address - Street 1: | 2471 W HARRIET LN |
Mailing Address - Street 2: | |
Mailing Address - City: | ANAHEIM |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92804-5212 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-696-1099 |
Mailing Address - Fax: | 714-236-5123 |
Practice Address - Street 1: | 7891 WESTMINSTER BLVD |
Practice Address - Street 2: | |
Practice Address - City: | WESTMINSTER |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92683-4043 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-696-1099 |
Practice Address - Fax: | 714-236-5123 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-01-20 |
Last Update Date: | 2016-01-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | AC12267 | 171100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | Group - Single Specialty |