Healthcare Provider Details

I. General information

NPI: 1255464095
Provider Name (Legal Business Name): OC LIVEWELL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W CALIFORNIA BLVD
PASADENA CA
91105-3005
US

IV. Provider business mailing address

107 W CALIFORNIA BLVD
PASADENA CA
91105-3005
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-1799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SENGSOO HAN
Title or Position: PRESIDENT
Credential:
Phone: 626-396-1799