Healthcare Provider Details

I. General information

NPI: 1154914000
Provider Name (Legal Business Name): ABRAHAM ACUPUNCTURE & HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 W ORANGETHORPE AVE
FULLERTON CA
92833-4405
US

IV. Provider business mailing address

1817 W ORANGETHORPE AVE
FULLERTON CA
92833-4405
US

V. Phone/Fax

Practice location:
  • Phone: 714-449-0911
  • Fax: 714-449-2005
Mailing address:
  • Phone: 714-449-0911
  • Fax: 714-449-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM K SHIN
Title or Position: ACUPUNCTURIST
Credential: L.AC
Phone: 714-449-0911