Provider Demographics
NPI:1356597553
Name:MAEDA, ATSUKI (LAC)
Entity type:Individual
Prefix:MR
First Name:ATSUKI
Middle Name:
Last Name:MAEDA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 LOMITA BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3934
Mailing Address - Country:US
Mailing Address - Phone:310-373-5524
Mailing Address - Fax:
Practice Address - Street 1:3655 LOMITA BLVD STE 308
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3934
Practice Address - Country:US
Practice Address - Phone:310-373-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4608171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist