Healthcare Provider Details

I. General information

NPI: 1578685095
Provider Name (Legal Business Name): LAURA HUANG L . AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23361 EL TORO RD STE 106
LAKE FOREST CA
92630-4810
US

IV. Provider business mailing address

23361 EL TORO RD STE 106
LAKE FOREST CA
92630-4810
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-8119
  • Fax:
Mailing address:
  • Phone: 949-855-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 5374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: