Provider Demographics
NPI:1316624869
Name:DE-YI CHINESE HERB & ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:DE-YI CHINESE HERB & ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PU
Authorized Official - Middle Name:POLLY
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-633-0398
Mailing Address - Street 1:9368 VALLEY BLVD
Mailing Address - Street 2:103
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1990
Mailing Address - Country:US
Mailing Address - Phone:323-633-0398
Mailing Address - Fax:626-380-4069
Practice Address - Street 1:9368 VALLEY BLVD
Practice Address - Street 2:103
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1990
Practice Address - Country:US
Practice Address - Phone:323-633-0398
Practice Address - Fax:626-380-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty