Provider Demographics
NPI:1811309842
Name:APRICOT GROVE ACUPUNCTURE
Entity type:Organization
Organization Name:APRICOT GROVE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:EUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:661-434-3415
Mailing Address - Street 1:2920 F ST
Mailing Address - Street 2:SUITE F 11
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-434-3415
Mailing Address - Fax:888-498-7692
Practice Address - Street 1:2920 F ST
Practice Address - Street 2:SUITE F 11
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-434-3415
Practice Address - Fax:888-498-7692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-26
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13318171100000X
CA11521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982829636OtherACUPUNCTURIST
1386969202OtherACUPUNCTURIST