Healthcare Provider Details

I. General information

NPI: 1922675313
Provider Name (Legal Business Name): LEI SONG L.AC, MSAOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 06/05/2021
Certification Date: 06/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 HUNTINGTON DR STE 200
PASADENA CA
91107-5522
US

IV. Provider business mailing address

596 W HUNTINGTON DR UNIT D
ARCADIA CA
91007-3463
US

V. Phone/Fax

Practice location:
  • Phone: 323-842-7886
  • Fax:
Mailing address:
  • Phone: 323-842-7886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC18878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: