Provider Demographics
NPI:1548646409
Name:EASTERN ACUPUNCTURE & HERBAL CLINIC
Entity type:Organization
Organization Name:EASTERN ACUPUNCTURE & HERBAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-255-2558
Mailing Address - Street 1:4651 ROSWELL RD
Mailing Address - Street 2:BUILDING I SUITE-801
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3048
Mailing Address - Country:US
Mailing Address - Phone:404-255-2558
Mailing Address - Fax:
Practice Address - Street 1:4651 ROSWELL RD
Practice Address - Street 2:BUILDING I SUITE-801
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3048
Practice Address - Country:US
Practice Address - Phone:404-255-2558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty