Healthcare Provider Details

I. General information

NPI: 1487560058
Provider Name (Legal Business Name): EDEN ACUPUNCTURE & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17501 IRVINE BLVD STE 103
TUSTIN CA
92780-3147
US

IV. Provider business mailing address

17501 IRVINE BLVD STE 103
TUSTIN CA
92780-3147
US

V. Phone/Fax

Practice location:
  • Phone: 714-932-8512
  • Fax: 949-390-9902
Mailing address:
  • Phone: 714-932-8512
  • Fax: 949-390-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MR. SEOK LEE
Title or Position: CEO/CFO/SECRETARY
Credential: ACUPUNCTURIST
Phone: 714-932-8512