Provider Demographics
NPI:1982457891
Name:EAST-WESTERN MEDICAL
Entity Type:Organization
Organization Name:EAST-WESTERN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONG GWON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DAOM, LAC
Authorized Official - Phone:310-935-8703
Mailing Address - Street 1:1144 S WESTERN AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2376
Mailing Address - Country:US
Mailing Address - Phone:310-935-8703
Mailing Address - Fax:213-722-5025
Practice Address - Street 1:1144 S WESTERN AVE STE 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2376
Practice Address - Country:US
Practice Address - Phone:310-935-8703
Practice Address - Fax:213-722-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty