Healthcare Provider Details

I. General information

NPI: 1194690982
Provider Name (Legal Business Name): LIFE AND NATURE WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N BROOKHURST ST STE 204
ANAHEIM CA
92801-5236
US

IV. Provider business mailing address

1000 N ROANNE PL UNIT B
ANAHEIM CA
92801-3206
US

V. Phone/Fax

Practice location:
  • Phone: 714-443-1779
  • Fax: 855-224-7041
Mailing address:
  • Phone: 949-839-3259
  • Fax: 855-224-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SOO JIN CHO
Title or Position: PRESIDENT
Credential: LAC
Phone: 949-839-3259