Healthcare Provider Details

I. General information

NPI: 1700103306
Provider Name (Legal Business Name): SUNNY BOHWA ACUPUNCTURE HERB CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 S. BEACH BL
LA HABRA CA
90631
US

IV. Provider business mailing address

143 S. BEACH BL
LA HABRA CA
90631
US

V. Phone/Fax

Practice location:
  • Phone: 562-756-8757
  • Fax: 562-690-6777
Mailing address:
  • Phone: 562-756-8557
  • Fax: 562-690-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10135
License Number StateCA

VIII. Authorized Official

Name: MRS. SUNNY WHITE
Title or Position: OM. PHD.
Credential: L.A.C. OM PHD
Phone: 562-756-8757