Healthcare Provider Details

I. General information

NPI: 1033422761
Provider Name (Legal Business Name): ARK ACUPUNCTURE & HERB PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22706 ASPAN ST SUITE 504
LAKE FOREST CA
92630-1603
US

IV. Provider business mailing address

22706 ASPAN ST SUITE 504
LAKE FOREST CA
92630-1603
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-1100
  • Fax: 949-454-2820
Mailing address:
  • Phone: 949-857-1100
  • Fax: 949-454-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13172
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License NumberAC13399
License Number StateCA

VIII. Authorized Official

Name: MRS. HSING TSENG CHU
Title or Position: PRESIDENT
Credential: L.AC
Phone: 949-857-1100