Healthcare Provider Details

I. General information

NPI: 1932589835
Provider Name (Legal Business Name): IRVINE HEALTHCARE ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16444 PARAMOUNT BLVD. SUITE 208
PARAMOUNT CA
90723
US

IV. Provider business mailing address

16444 PARAMOUNT BLVD. SUITE 208
PARAMOUNT CA
90723
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-7052
  • Fax: 562-444-0701
Mailing address:
  • Phone: 310-933-7052
  • Fax: 562-444-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9039
License Number StateCA

VIII. Authorized Official

Name: HYONGCHOL LEE
Title or Position: OWNER
Credential:
Phone: 213-447-3538