Healthcare Provider Details

I. General information

NPI: 1417525320
Provider Name (Legal Business Name): NATURE ACUPUNCTURE & HERB CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W BELLEVUE DR STE 1
PASADENA CA
91105-2548
US

IV. Provider business mailing address

117 W BELLEVUE DR STE 1
PASADENA CA
91105-2548
US

V. Phone/Fax

Practice location:
  • Phone: 626-376-2172
  • 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: NAM JO KIM PAN
Title or Position: OWNER
Credential: L.AC
Phone: 626-376-2172