# FANG MAO MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Profound Youth Acupuncture
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477875862
- **Authorized official:** DR. CHI FANG HSU L.AC., O.M.D. (ACUPUNCTURIST / PRESIDENT)
- **Authorized official phone:** (951) 582-0999

## Contact information

- **Practice address:** 760 WASHBURN AVE, SUITE \# 23, CORONA, CA 92882-3303
- **Practice address phone:** (951) 582-0999
- **Practice address fax:** (951) 582-0900
- **Mailing address:** 760 WASHBURN AVE, SUITE \# 23, CORONA, CA 92882-3303
- **Mailing address phone:** (951) 582-0999
- **Mailing address fax:** (951) 582-0900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | AC11187 | CA | Yes |

## Other

- **Enumeration date:** 02/25/2010
- **Last updated:** 02/25/2010