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General NPI Number Information
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NPI Number | 1124485289
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Entity Type | Organization
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Legal Business Name | WELLNESS ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 1866 E MAIN ST
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City | BARSTOW
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State | CA
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Zip | 92311
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Country | US
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Telephone | 213-905-0566
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Fax |
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Provider Business Mailing Address
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Address Line | 1866 E MAIN ST
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City | BARSTOW
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State | CA
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Zip | 92311
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Country | US
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Telephone | 213-905-0566
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAE HUI LEE
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Credential | OMD. LAC
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Telephone | 213-905-0566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | AC15436
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License Number State | CA
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