Healthcare Provider Details

I. General information

NPI: 1023354206
Provider Name (Legal Business Name): SANG HEE SHIN DACM, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41840 ENTERPRISE CIR N
TEMECULA CA
92590-5654
US

IV. Provider business mailing address

41840 ENTERPRISE CIR N
TEMECULA CA
92590-5654
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax:
Mailing address:
  • Phone: 833-867-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: