Healthcare Provider Details

I. General information

NPI: 1841047198
Provider Name (Legal Business Name): TAI YI NATURAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25571 JERONIMO RD STE 10
MISSION VIEJO CA
92691-2726
US

IV. Provider business mailing address

25571 JERONIMO RD STE 10
MISSION VIEJO CA
92691-2726
US

V. Phone/Fax

Practice location:
  • Phone: 949-613-4022
  • Fax:
Mailing address:
  • Phone: 949-613-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GOLDFE ZENG
Title or Position: MANAGER
Credential:
Phone: 909-938-9090