1639611395 NPI number — LIFE & HEALTH ACUPUNCTURE & HERBS

Table of content: (NPI 1639611395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639611395 NPI number — LIFE & HEALTH ACUPUNCTURE & HERBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE & HEALTH ACUPUNCTURE & HERBS
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:
수강한의원
Provider Other Organization Name Type Code:
5
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:
1639611395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S FLOWER ST UNIT 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-3458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-434-1598
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9872 CHAPMAN AVE
Provider Second Line Business Practice Location Address:
SUITE #114
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92841-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-408-1169
Provider Business Practice Location Address Fax Number:
714-408-1169
Provider Enumeration Date:
11/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KANG
Authorized Official First Name:
SUSANNAH
Authorized Official Middle Name:
KIM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
213-434-1598

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC17274 , 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)





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