Provider Demographics
NPI:1942733613
Name:GREEN ACUPUNCTURE, PROF. CORP.
Entity Type:Organization
Organization Name:GREEN ACUPUNCTURE, PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUNG LIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-780-5698
Mailing Address - Street 1:13788 ROSWELL AVE
Mailing Address - Street 2:#138
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1409
Mailing Address - Country:US
Mailing Address - Phone:626-780-5698
Mailing Address - Fax:
Practice Address - Street 1:13788 ROSWELL AVE
Practice Address - Street 2:#138
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1409
Practice Address - Country:US
Practice Address - Phone:626-780-5698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17447171100000X
CAAC17449171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty