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General NPI Number Information
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NPI Number | 1396983250
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE ACUPUNCTURE CENTER
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 1241 S SOTO ST STE 110
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City | LOS ANGELES
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State | CA
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Zip | 90023-2666
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Country | US
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Telephone | 323-264-3288
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Fax | 323-264-0288
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Provider Business Mailing Address
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Address Line | 1241 S SOTO ST STE 110
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City | LOS ANGELES
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State | CA
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Zip | 90023-2666
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Country | US
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Telephone | 323-264-3288
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Fax | 323-264-0288
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MRS. KIMI XIAO GUDMUNSEN
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Credential | L.AC.,O.M.D., PH.D
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Telephone | 323-264-3288
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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 | AC8229
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License Number State | CA
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