Provider Demographics
NPI:1538832258
Name:A&C WELLPOINT INC
Entity type:Organization
Organization Name:A&C WELLPOINT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MI OK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-532-8008
Mailing Address - Street 1:PO BOX 2895
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1095
Mailing Address - Country:US
Mailing Address - Phone:310-532-8008
Mailing Address - Fax:213-388-7941
Practice Address - Street 1:3407 W 6TH ST STE 617
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2553
Practice Address - Country:US
Practice Address - Phone:310-532-8008
Practice Address - Fax:213-388-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty