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General NPI Number Information
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NPI Number | 1255824850
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Entity Type | Organization
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Legal Business Name | SANDEE WELLNESS CENTER 2018, INC
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 1253 VINE ST STE 10
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City | LOS ANGELES
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State | CA
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Zip | 90038-1662
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Country | US
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Telephone | 323-747-0987
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Fax | 323-395-0428
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Provider Business Mailing Address
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Address Line | 1253 VINE ST STE 10
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City | LOS ANGELES
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State | CA
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Zip | 90038-1662
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Country | US
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Telephone | 323-747-0987
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Fax | 323-395-0428
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Authorized Official
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Title or Position | OWNER
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Name | CHALAIPORN IAMSIRITHAWORN
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Credential | LAC.
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Telephone | 323-747-0987
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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 |
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License Number State | CA
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