Healthcare Provider Details

I. General information

NPI: 1588590343
Provider Name (Legal Business Name): RED LEAF ACUPUNCTURE & HERBAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 BALBOA AVE STE 321
SAN DIEGO CA
92111-2254
US

IV. Provider business mailing address

7710 BALBOA AVE STE 321
SAN DIEGO CA
92111-2254
US

V. Phone/Fax

Practice location:
  • Phone: 858-394-6688
  • Fax: 858-868-8033
Mailing address:
  • Phone: 858-394-6688
  • Fax: 858-868-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEVIN YOUNG
Title or Position: CEO
Credential: DACM
Phone: 702-773-6504