Healthcare Provider Details

I. General information

NPI: 1881790558
Provider Name (Legal Business Name): YUANCHUN HUANG L.AC, OMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 FAIR DR STE S
COSTA MESA CA
92626-6242
US

IV. Provider business mailing address

25085 MACKENZIE ST
LAGUNA HILLS CA
92653-5082
US

V. Phone/Fax

Practice location:
  • Phone: 714-751-8789
  • Fax: 714-751-8799
Mailing address:
  • Phone: 714-751-8789
  • Fax: 714-751-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 5963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: