Provider Demographics
NPI:1689126781
Name:SOORIM ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:SOORIM ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WOO JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:657-208-1153
Mailing Address - Street 1:780 N EUCLID ST
Mailing Address - Street 2:STE 110
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4134
Mailing Address - Country:US
Mailing Address - Phone:657-208-1153
Mailing Address - Fax:657-208-1156
Practice Address - Street 1:780 N EUCLID ST
Practice Address - Street 2:STE 110
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4134
Practice Address - Country:US
Practice Address - Phone:657-208-1153
Practice Address - Fax:657-208-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14020171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty