Look up the most recent NPI and PECOS records

Evergreen Acupuncture & Wellness Clinic

Acupuncturist

Other Service Providers

422 W La Habra Blvd, La Habra, CA 90631-5408

(562) 524-2091

PECOS Enrollment

Based on the most recent information from CMS, provider Evergreen Acupuncture & Wellness Clinic does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 34 days ago.

Profile Details

Provider ID
1295372530
Provider Type
Organization
Full Name
Evergreen Acupuncture & Wellness Clinic

Subpart
No
Enumeration Date
12/5/2019
Last Updated
12/5/2019

Contact Information

Practice Location

422 W La Habra Blvd, La Habra, CA 90631-5408

(562) 524-2091

Unlisted Fax

Mailing Location

422 W La Habra Blvd, La Habra, CA 90631-5408

Unlisted Phone

Unlisted Fax

Authorized Official

Choi, Peter (Ceo)

(562) 524-2091

Provider Taxonomies

Code	Description	License
Code 171100000X Primary	Description Acupuncturist Other Service Providers	License Unlisted Issuer

Evergreen Acupuncture & Wellness Clinic

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

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Jang, Inok

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Kim, Dae Yong

Oh, Se Kyun

Kim, Cheol

Acubalance Clinic

Namgoong, Won

Park, Nam Woon

Lee, Esther