Healthcare Provider Details

I. General information

NPI: 1861168916
Provider Name (Legal Business Name): AI-GEN HUANG LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MADISON AVE APT D18
FULLERTON CA
92831-2233
US

IV. Provider business mailing address

2800 MADISON AVE APT D18
FULLERTON CA
92831-2233
US

V. Phone/Fax

Practice location:
  • Phone: 714-398-7796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: