Healthcare Provider Details

I. General information

NPI: 1023331766
Provider Name (Legal Business Name): HARVEST HEALTH CLINIC FOR ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N TUSTIN AVE 702
SANTA ANA CA
92705-3612
US

IV. Provider business mailing address

801 N TUSTIN AVE 302
SANTA ANA CA
92705-3612
US

V. Phone/Fax

Practice location:
  • Phone: 714-564-0226
  • Fax: 866-406-6113
Mailing address:
  • Phone: 714-564-0226
  • Fax: 888-510-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29675
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13080
License Number StateCA

VIII. Authorized Official

Name: MRS. JUNGHWA SARAH PARK
Title or Position: MEMBER
Credential: DAOM, MSAOM, LAC
Phone: 714-564-0226