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General NPI Number Information
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NPI Number | 1275775504
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Entity Type | Organization
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Legal Business Name | LONGLIFE ACUPUNCTURE INC.
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 3042 S. HACIENDA BLVD
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745
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Country | US
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Telephone | 626-369-0998
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Fax | 626-965-3395
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Provider Business Mailing Address
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Address Line | 3042 S. HACIENDA BLVD
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745
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Country | US
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Telephone | 626-369-0998
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Fax | 626-965-3395
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Authorized Official
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Title or Position | DR
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Name | MR. CHANGSHAN XIN SR.
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Credential |
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Telephone | 626-369-0998
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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 | AC7726
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License Number State | CA
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