Provider Demographics
NPI:1700181864
Name:FOREVER GREEN ACUPUNCTURE
Entity Type:Organization
Organization Name:FOREVER GREEN ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-382-2349
Mailing Address - Street 1:3850 WILSHIRE BL
Mailing Address - Street 2:#220
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3850 WILSHIRE BL
Practice Address - Street 2:#220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:213-382-2349
Practice Address - Fax:213-325-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty