Provider Demographics
NPI:1194486563
Name:EJ BANG'S ACUPUNCTURE
Entity type:Organization
Organization Name:EJ BANG'S ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC, DAOM
Authorized Official - Prefix:
Authorized Official - First Name:EUNJU
Authorized Official - Middle Name:
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-510-0704
Mailing Address - Street 1:6513 KOREMATSU CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4571
Mailing Address - Country:US
Mailing Address - Phone:408-510-0704
Mailing Address - Fax:408-323-8504
Practice Address - Street 1:841 BLOSSOM HILL RD STE 107
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2704
Practice Address - Country:US
Practice Address - Phone:408-510-0704
Practice Address - Fax:408-323-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty