Provider Demographics
NPI:1053009324
Name:CELESTIAL ACUPUNCTURE & EAST ASIAN MEDICINE, LLC
Entity type:Organization
Organization Name:CELESTIAL ACUPUNCTURE & EAST ASIAN MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:907-726-7070
Mailing Address - Street 1:15-2660 PAHOA VILLAGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-6722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15-2660 PAHOA VILLAGE RD STE 203
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-6722
Practice Address - Country:US
Practice Address - Phone:808-900-3654
Practice Address - Fax:808-500-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty