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General NPI Number Information
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NPI Number | 1124486527
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Entity Type | Organization
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Legal Business Name | BONWELLNESS CLINIC, INC
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 02/13/2016
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Provider Practice Location Address
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Address Line | 7212 ORANGETHORPE AVE STE 6
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City | BUENA PARK
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State | CA
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Zip | 90621-3341
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Country | US
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Telephone | 714-520-1359
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Fax | 714-509-1616
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Provider Business Mailing Address
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Address Line | 7212 ORANGETHORPE AVE STE 6
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City | BUENA PARK
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State | CA
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Zip | 90621-3341
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Country | US
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Telephone | 714-520-1359
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Fax | 714-509-1616
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JAE SUNG BYUN
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Credential |
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Telephone | 714-520-1359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC13811
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License Number State | CA
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