Healthcare Provider Details

I. General information

NPI: 1316283021
Provider Name (Legal Business Name): LONGTENG INTERNATIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 WALNUT AVE STE 4
TUSTIN CA
92780-6944
US

IV. Provider business mailing address

3792 BLACKTHORN ST
IRVINE CA
92606-2604
US

V. Phone/Fax

Practice location:
  • Phone: 949-331-5716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 14841
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15023
License Number StateCA

VIII. Authorized Official

Name: JIANJUN FENG
Title or Position: OWNER/MANAGER
Credential:
Phone: 949-331-5716