1760637417 NPI number — BALANCE & HARMONY WELLNESS, INC.

Table of content: (NPI 1760637417)

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:
Provider Other Organization Name Type Code:
6
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".