Provider Demographics
NPI:1134542707
Name:SAGE HERB & ACUPUNCTURE
Entity type:Organization
Organization Name:SAGE HERB & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MI SOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:PREGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-650-7170
Mailing Address - Street 1:17127 PIONEER BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-2757
Mailing Address - Country:US
Mailing Address - Phone:562-650-7170
Mailing Address - Fax:
Practice Address - Street 1:17127 PIONEER BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-2757
Practice Address - Country:US
Practice Address - Phone:562-650-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-01
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3411281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty