Healthcare Provider Details

I. General information

NPI: 1376806612
Provider Name (Legal Business Name): SHANGRILA CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 ALMA REAL DR T - 04
PACIFIC PALISADES CA
90272-3731
US

IV. Provider business mailing address

881 ALMA REAL DR T - 04
PACIFIC PALISADES CA
90272-3731
US

V. Phone/Fax

Practice location:
  • Phone: 310-230-0008
  • Fax:
Mailing address:
  • Phone: 310-230-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name: YAOYU WANG
Title or Position: OWNER
Credential: PHD
Phone: 818-644-2171