Healthcare Provider Details

I. General information

NPI: 1083323554
Provider Name (Legal Business Name): BONNIE YAN HUANG LAC, D.ACU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 VALLEY BLVD UNIT H
ROSEMEAD CA
91770
US

IV. Provider business mailing address

8780 VALLEY BLVD UNIT H
ROSEMEAD CA
91770
US

V. Phone/Fax

Practice location:
  • Phone: 626-778-7788
  • Fax:
Mailing address:
  • Phone: 626-778-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC18885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: