Healthcare Provider Details

I. General information

NPI: 1255824850
Provider Name (Legal Business Name): SANDEE WELLNESS CENTER 2018, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 VINE ST STE 10
LOS ANGELES CA
90038-1662
US

IV. Provider business mailing address

1253 VINE ST STE 10
LOS ANGELES CA
90038-1662
US

V. Phone/Fax

Practice location:
  • Phone: 323-747-0987
  • Fax: 323-395-0428
Mailing address:
  • Phone: 323-747-0987
  • Fax: 323-395-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHALAIPORN IAMSIRITHAWORN
Title or Position: OWNER
Credential: LAC.
Phone: 323-747-0987