Healthcare Provider Details

I. General information

NPI: 1285147512
Provider Name (Legal Business Name): HAN-SOL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22672 LAMBERT ST STE 616
LAKE FOREST CA
92630-1613
US

IV. Provider business mailing address

22672 LAMBERT ST STE 616
LAKE FOREST CA
92630-1613
US

V. Phone/Fax

Practice location:
  • Phone: 213-342-7039
  • Fax: 800-285-2176
Mailing address:
  • Phone: 213-342-7039
  • Fax: 800-285-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16758
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YOUNG SOON CHOI
Title or Position: CEO
Credential: L.AC
Phone: 213-342-7039