Healthcare Provider Details

I. General information

NPI: 1003301433
Provider Name (Legal Business Name): AGLAIA ACUPUNCTURE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 S SEPULVEDA BLVD STE 100
LOS ANGELES CA
90045-3616
US

IV. Provider business mailing address

8838 DE HAVILAND AVE
LOS ANGELES CA
90045-4114
US

V. Phone/Fax

Practice location:
  • Phone: 310-878-0789
  • Fax:
Mailing address:
  • Phone: 818-428-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17554
License Number StateCA

VIII. Authorized Official

Name: YUNUEN BERISTAIN
Title or Position: PRESIDENT
Credential: L.AC.
Phone: 818-428-9858