Healthcare Provider Details

I. General information

NPI: 1174472377
Provider Name (Legal Business Name): OAK SONG ACUPUNCTURE AND WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD STE 126
PASADENA CA
91105-2551
US

IV. Provider business mailing address

421 MISSION ST APT H
SOUTH PASADENA CA
91030-3047
US

V. Phone/Fax

Practice location:
  • Phone: 626-390-3189
  • Fax:
Mailing address:
  • Phone: 626-390-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURA DERR
Title or Position: OWNER
Credential: LICENSED ACUPUNCTURI
Phone: 626-390-3189