1316283021 NPI number — LONGTENG INTERNATIONAL INC

Table of content: (NPI 1316283021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316283021 NPI number — LONGTENG INTERNATIONAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONGTENG INTERNATIONAL 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:
LONGTENG ACUPUNCTURE INC
Provider Other Organization Name Type Code:
3
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:
1316283021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3792 BLACKTHORN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92606-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2512 WALNUT AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780-6944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-331-5716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FENG
Authorized Official First Name:
JIANJUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
949-331-5716

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC 14841 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: 15023 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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