Healthcare Provider Details

I. General information

NPI: 1215172952
Provider Name (Legal Business Name): NEW LIFE ACUPUNCTURE AND HERBS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 CENTRAL AVE SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

4716 CENTRAL AVE SE
ALBUQUERQUE NM
87108
US

V. Phone/Fax

Practice location:
  • Phone: 505-710-7504
  • Fax:
Mailing address:
  • Phone: 505-710-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number960
License Number StateNM

VIII. Authorized Official

Name: DR. SANGSOON CHANG
Title or Position: D.O.M
Credential:
Phone: 15057107504