1760637417 NPI number — BALANCE & HARMONY WELLNESS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760637417 NPI number — BALANCE & HARMONY WELLNESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALANCE & HARMONY WELLNESS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BALANCE & HARMONY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760637417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S KINGSLEY DR APT 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90020-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-359-8889
Provider Business Mailing Address Fax Number:
626-305-3149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W HUNTINGTON DR STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91007-3478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-461-5228
Provider Business Practice Location Address Fax Number:
--
Provider Enumeration Date:
11/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
SANG
Authorized Official Middle Name:
KUN
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
626-461-5228

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC 10623 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5989736 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".