Healthcare Provider Details

I. General information

NPI: 1851701031
Provider Name (Legal Business Name): WAYNE HUO L.AC., DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S HACIENDA BLVD STE D
HACIENDA HEIGHTS CA
91745-4265
US

IV. Provider business mailing address

2020 S HACIENDA BLVD STE D
HACIENDA HEIGHTS CA
91745-4265
US

V. Phone/Fax

Practice location:
  • Phone: 626-855-1158
  • Fax: 626-605-5015
Mailing address:
  • Phone: 626-855-1158
  • Fax: 626-605-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36008
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: