Healthcare Provider Details

I. General information

NPI: 1255488672
Provider Name (Legal Business Name): A PRIME ACUPUNCTURE & HERB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 S. BRISTOL ST. # 108
SANTA ANA CA
92704-6210
US

IV. Provider business mailing address

2720 S. BRISTOL ST. # 108
SANTA ANA CA
92704-6210
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-4859
  • Fax: 714-546-4859
Mailing address:
  • Phone: 714-546-4859
  • Fax: 714-546-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7710
License Number StateCA

VIII. Authorized Official

Name: DIANA NGUYEN-THIEN-NHON
Title or Position: PRESIDENT
Credential: LIC. AC., PH.D.
Phone: 714-546-4859