Healthcare Provider Details

I. General information

NPI: 1003720855
Provider Name (Legal Business Name): HARRY BENJAMIN POLSTEIN DACM L.AC ANMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 2ND AVE
SAN DIEGO CA
92103-5612
US

IV. Provider business mailing address

2353 FRONT ST
SAN DIEGO CA
92101-1413
US

V. Phone/Fax

Practice location:
  • Phone: 619-405-4144
  • Fax:
Mailing address:
  • Phone: 619-405-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20486
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number76723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: