Provider Demographics
NPI:1861907784
Name:MODERN MEDIAL ALTERNATIVE
Entity type:Organization
Organization Name:MODERN MEDIAL ALTERNATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIA BING
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD L AC
Authorized Official - Phone:626-242-7695
Mailing Address - Street 1:P.O. BOX 90851
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91715
Mailing Address - Country:US
Mailing Address - Phone:626-242-7695
Mailing Address - Fax:626-964-2659
Practice Address - Street 1:18232 GALE AVE
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748
Practice Address - Country:US
Practice Address - Phone:626-242-7695
Practice Address - Fax:626-964-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty