Provider Demographics
NPI:1225865173
Name:DERBY ACUPUNCTURE, INC.
Entity type:Organization
Organization Name:DERBY ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERBY
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-896-8809
Mailing Address - Street 1:4220 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-3736
Mailing Address - Country:US
Mailing Address - Phone:310-896-8809
Mailing Address - Fax:866-768-9051
Practice Address - Street 1:4220 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-3736
Practice Address - Country:US
Practice Address - Phone:310-896-8809
Practice Address - Fax:866-768-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty