Healthcare Provider Details

I. General information

NPI: 1225460116
Provider Name (Legal Business Name): BO CHENG HUANG L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 HATHAWAY AVE
ALHAMBRA CA
91803-3941
US

IV. Provider business mailing address

2137 HATHAWAY AVE
ALHAMBRA CA
91803-3941
US

V. Phone/Fax

Practice location:
  • Phone: 626-278-4451
  • Fax:
Mailing address:
  • Phone: 626-278-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 15352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: