Provider Demographics
NPI:1740487479
Name:CALLE MAYOR ACUPTUNCTURE & HERB
Entity type:Organization
Organization Name:CALLE MAYOR ACUPTUNCTURE & HERB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-378-8788
Mailing Address - Street 1:4441 CALLE MAYOR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4431
Mailing Address - Country:US
Mailing Address - Phone:310-378-8788
Mailing Address - Fax:
Practice Address - Street 1:4441 CALLE MAYOR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4431
Practice Address - Country:US
Practice Address - Phone:310-378-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5254171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty