Provider Demographics
NPI:1720422256
Name:BIJOU SKINCARE & ACUPUNCTURE
Entity Type:Organization
Organization Name:BIJOU SKINCARE & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC. / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUNJA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-943-1234
Mailing Address - Street 1:1401 S BEACH BLVD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6377
Mailing Address - Country:US
Mailing Address - Phone:562-943-1234
Mailing Address - Fax:562-943-3000
Practice Address - Street 1:1401 S BEACH BLVD
Practice Address - Street 2:SUITE G1
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6377
Practice Address - Country:US
Practice Address - Phone:562-943-1234
Practice Address - Fax:562-943-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12339171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty