Healthcare Provider Details

I. General information

NPI: 1730863689
Provider Name (Legal Business Name): A-LYNN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 S LA CIENEGA BLVD STE 207
BEVERLY HILLS CA
90211-3336
US

IV. Provider business mailing address

292 S LA CIENEGA BLVD STE 207
BEVERLY HILLS CA
90211-3336
US

V. Phone/Fax

Practice location:
  • Phone: 424-302-3238
  • Fax:
Mailing address:
  • Phone: 424-302-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: SIYEON PARK
Title or Position: ACUPUNCTURIST
Credential: L.AC
Phone: 424-302-3238