Healthcare Provider Details

I. General information

NPI: 1326575713
Provider Name (Legal Business Name): KEVIN SHIH-WEN HUANG LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11383 183RD ST
CERRITOS CA
90703-5434
US

IV. Provider business mailing address

11383 183RD ST
CERRITOS CA
90703-5434
US

V. Phone/Fax

Practice location:
  • Phone: 562-832-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: