Healthcare Provider Details

I. General information

NPI: 1083931992
Provider Name (Legal Business Name): JODY HSU STEELE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2010
Last Update Date: 05/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20803 VALLEY BLVD STE 103
WALNUT CA
91789-2582
US

IV. Provider business mailing address

15534 DUKE AVE
CHINO HILLS CA
91709-2873
US

V. Phone/Fax

Practice location:
  • Phone: 909-598-2111
  • Fax:
Mailing address:
  • Phone: 909-393-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: