Healthcare Provider Details

I. General information

NPI: 1336919281
Provider Name (Legal Business Name): LIFELINE ACU INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 WHITNEY AVE
CARMICHAEL CA
95608-2953
US

IV. Provider business mailing address

4701 WHITNEY AVE
CARMICHAEL CA
95608-2953
US

V. Phone/Fax

Practice location:
  • Phone: 916-589-7020
  • Fax: 530-756-1450
Mailing address:
  • Phone: 916-589-7020
  • Fax: 530-756-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. HONG JOON LEE
Title or Position: OWNER
Credential:
Phone: 916-335-1752