1770877839 NPI number — LIFETREE ACUPUNCTURE AND HERBAL MEDICINE

Table of content: HENRY LAURIS PAULSON MD (NPI 1497748537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770877839 NPI number — LIFETREE ACUPUNCTURE AND HERBAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFETREE ACUPUNCTURE AND HERBAL MEDICINE
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:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770877839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12920 SW 83RD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-5927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-256-9424
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2580 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33322-3055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-772-4524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
JUNGHYUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-772-4524

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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