Provider Demographics
NPI:1184096257
Name:RENEW ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:RENEW ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DOO
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC PHD
Authorized Official - Phone:714-538-9988
Mailing Address - Street 1:1132 E KATELLA AVE STE A14
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5044
Mailing Address - Country:US
Mailing Address - Phone:714-538-9988
Mailing Address - Fax:
Practice Address - Street 1:1132 E KATELLA AVENUE STE. A14
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867
Practice Address - Country:US
Practice Address - Phone:714-538-9988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6818302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization