Provider Demographics
NPI:1841367414
Name:EAST WEST CLINIC
Entity type:Organization
Organization Name:EAST WEST CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLET
Authorized Official - Middle Name:STELLA
Authorized Official - Last Name:LAHOZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC RN
Authorized Official - Phone:651-429-9595
Mailing Address - Street 1:5770 W BALD EAGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-6440
Mailing Address - Country:US
Mailing Address - Phone:651-429-9595
Mailing Address - Fax:651-429-9595
Practice Address - Street 1:5770 W BALD EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-6440
Practice Address - Country:US
Practice Address - Phone:651-429-9595
Practice Address - Fax:651-429-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN55054OtherHP GROUP NUMBER
MN24137JEOtherBCBS GROUP NUMBER