Provider Demographics
NPI:1265620926
Name:10 BODY TYPE ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:10 BODY TYPE ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-675-0111
Mailing Address - Street 1:5770 MELROSE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3873
Mailing Address - Country:US
Mailing Address - Phone:213-675-0111
Mailing Address - Fax:
Practice Address - Street 1:5770 MELROSE AVE STE 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3873
Practice Address - Country:US
Practice Address - Phone:213-675-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty