Healthcare Provider Details

I. General information

NPI: 1639644362
Provider Name (Legal Business Name): TRADITIONAL ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20709 GOLDEN SPRINGS DR
WALNUT CA
91789-3847
US

IV. Provider business mailing address

5554 NEWBRIAR WAY
CHINO HILLS CA
91709-8799
US

V. Phone/Fax

Practice location:
  • Phone: 626-247-1398
  • Fax:
Mailing address:
  • Phone: 626-247-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHANSHAN LIU
Title or Position: ACUPUNCTURIST
Credential:
Phone: 626-247-1398