Healthcare Provider Details

I. General information

NPI: 1942606561
Provider Name (Legal Business Name): REAL HEALTH ACUPUNCTURE & HERBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5385 WALNUT AVE SUITE 7
CHINO CA
91710-2605
US

IV. Provider business mailing address

5385 WALNUT AVE SUITE 7
CHINO CA
91710-2605
US

V. Phone/Fax

Practice location:
  • Phone: 909-628-5880
  • Fax: 909-628-5882
Mailing address:
  • Phone: 909-628-5880
  • Fax: 909-628-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16179
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. YAN YU
Title or Position: OWNER
Credential: LAC
Phone: 909-628-5880