Healthcare Provider Details

I. General information

NPI: 1669879656
Provider Name (Legal Business Name): SUPERIOR MEDICAL WELLNESS CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 PACIFIC AVE SUITE 300
LONG BEACH CA
90806-2657
US

IV. Provider business mailing address

2690 PACIFIC AVE SUITE 300
LONG BEACH CA
90806-2657
US

V. Phone/Fax

Practice location:
  • Phone: 562-786-7184
  • Fax: 310-693-5518
Mailing address:
  • Phone: 562-786-7184
  • Fax: 310-693-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8056
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateCA

VIII. Authorized Official

Name: LU X YANG
Title or Position: PRESIDENT
Credential: L.A.C
Phone: 310-819-0682