Eagle Classic Wellness Inc

Primary specialty

AcupuncturistTaxonomy code 171100000X

Legal business name

EAGLE CLASSIC WELLNESS INC

Practice address

1914 S Western Ave
Los Angeles, CA 90018-1537

Phone

(909) 229-2721

NPI assigned

Feb 8, 2020

Last updated

Feb 8, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

EAGLE CLASSIC WELLNESS INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dock Ju CheongNPI 1346872264

Title

President

Phone

(909) 229-2721

Specialties & licenses 2

Addresses

Part of

Eagle Classic Wellness Inc

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dock Ju Cheong

  • Acupuncturist
  • Los Angeles, CA
  • NPI 1346872264
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581120000000",
    "number": "1437781366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1914 S WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900181537",
            "telephone_number": "909-229-2721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1914 S WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900181537",
            "telephone_number": "909-229-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE CLASSIC WELLNESS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE CLASSIC WELLNESS INC",
        "enumeration_date": "2020-02-08",
        "last_updated": "2020-02-08",
        "certification_date": "2020-02-08",
        "status": "A",
        "authorized_official_last_name": "CHEONG",
        "authorized_official_first_name": "DOCK JU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-229-2721"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.