=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457645814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN LIFE NATURAL HERBS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2011
-----------------------------------------------------
Last Update Date | 06/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10900 WESTMINSTER AVE STE 8
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-4918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-386-2404
-----------------------------------------------------
Fax | 714-363-5544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10900 WESTMINSTER AVE STE 8
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-4918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-386-2404
-----------------------------------------------------
Fax | 714-363-5544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SOPHIE THUY NGUYEN
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 714-386-2404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC9634
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------