Provider Demographics
NPI:1194928291
Name:MARINA ACUPUNCTURE CENTER, INC.
Entity type:Organization
Organization Name:MARINA ACUPUNCTURE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, OMD, PDD
Authorized Official - Phone:310-306-1212
Mailing Address - Street 1:13400 WASHINGTON BLVD STE 202-A
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5643
Mailing Address - Country:US
Mailing Address - Phone:310-306-1212
Mailing Address - Fax:
Practice Address - Street 1:13400 WASHINGTON BLVD STE 202-A
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5643
Practice Address - Country:US
Practice Address - Phone:310-306-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty