=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568868701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASENG ALTERNATIVE HEALTH CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2014
-----------------------------------------------------
Last Update Date | 11/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1950 SUNNYCREST DR SUITE 2000
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-773-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1950 SUNNYCREST DR SUITE 2000
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-773-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. WOO KYOUNG LEE
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 714-773-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC12314
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC14902
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------