Provider Demographics
NPI:1396942363
Name:MONTEBELLO NEWLIFE ACUPUNCTURE INC.
Entity type:Organization
Organization Name:MONTEBELLO NEWLIFE ACUPUNCTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:323-888-0540
Mailing Address - Street 1:709 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4709
Mailing Address - Country:US
Mailing Address - Phone:323-888-0540
Mailing Address - Fax:323-888-1722
Practice Address - Street 1:709 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4709
Practice Address - Country:US
Practice Address - Phone:323-888-0540
Practice Address - Fax:323-888-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC6470171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty