Healthcare Provider Details

I. General information

NPI: 1912630484
Provider Name (Legal Business Name): MINGDA LUO LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 S BALDWIN AVE STE A
ARCADIA CA
91007-7287
US

IV. Provider business mailing address

1012 S BALDWIN AVE STE A
ARCADIA CA
91007-7287
US

V. Phone/Fax

Practice location:
  • Phone: 213-304-2091
  • Fax:
Mailing address:
  • Phone: 213-304-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number39138
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: