Provider Demographics
NPI:1902082928
Name:EASTAO CORP.
Entity type:Organization
Organization Name:EASTAO CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHNG JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:909-989-7000
Mailing Address - Street 1:9602 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5035
Mailing Address - Country:US
Mailing Address - Phone:909-989-7000
Mailing Address - Fax:909-989-7000
Practice Address - Street 1:9602 BASELINE RD
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-5035
Practice Address - Country:US
Practice Address - Phone:909-989-7000
Practice Address - Fax:909-989-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10000305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC10000OtherACUPUNCTURIST