=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255364626
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED UNIVERSITY OF LOS ANGELES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12979 CENTRAL AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-628-1955
-----------------------------------------------------
Fax | 909-628-1085
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12979 CENTRAL AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-4122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-628-1955
-----------------------------------------------------
Fax | 909-628-1085
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SHUHONG TINA HOU
-----------------------------------------------------
Credential | L.AC., PH.D.
-----------------------------------------------------
Telephone | 909-628-1955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 5686
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------