Provider Demographics
NPI:1063294544
Name:ADVANCED TRADITIONAL ACUPUNCTURE
Entity type:Organization
Organization Name:ADVANCED TRADITIONAL ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:BUM
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:AC
Authorized Official - Phone:951-308-2646
Mailing Address - Street 1:27403 YNEZ RD STE 214
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4618
Mailing Address - Country:US
Mailing Address - Phone:951-308-2646
Mailing Address - Fax:951-308-6059
Practice Address - Street 1:27403 YNEZ RD STE 214
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4618
Practice Address - Country:US
Practice Address - Phone:951-308-2646
Practice Address - Fax:951-308-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty