Provider Demographics
NPI:1730615915
Name:ENERGY BODY ACUPUNCTURE INC.
Entity type:Organization
Organization Name:ENERGY BODY ACUPUNCTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUANG- CHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE ACUPUNCTURE
Authorized Official - Phone:818-437-8583
Mailing Address - Street 1:116 E BROADWAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1000
Mailing Address - Country:US
Mailing Address - Phone:818-437-8583
Mailing Address - Fax:
Practice Address - Street 1:116 E BROADWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1000
Practice Address - Country:US
Practice Address - Phone:818-437-8583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9818302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization