Provider Demographics
NPI:1831840040
Name:EMILY KIBA, LAC ACUPUNCTURE INC
Entity type:Organization
Organization Name:EMILY KIBA, LAC ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-721-2917
Mailing Address - Street 1:1976 S SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5620
Mailing Address - Country:US
Mailing Address - Phone:310-721-2917
Mailing Address - Fax:
Practice Address - Street 1:1976 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5620
Practice Address - Country:US
Practice Address - Phone:310-721-2917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty