Healthcare Provider Details

I. General information

NPI: 1962044438
Provider Name (Legal Business Name): LYNDA KIM-LINH VU L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 PACIFIC AVE STE A
LONG BEACH CA
90806-1468
US

IV. Provider business mailing address

7041 SOWELL AVE
WESTMINSTER CA
92683-5228
US

V. Phone/Fax

Practice location:
  • Phone: 562-310-1948
  • Fax:
Mailing address:
  • Phone: 714-837-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC18610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: