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General NPI Number Information
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NPI Number | 1588062061
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Entity Type | Organization
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Legal Business Name | PANACURE.INC
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 9872 CHAPMAN AVE STE 201
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City | GARDEN GROVE
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State | CA
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Zip | 92841-2733
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Country | US
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Telephone | 714-873-7793
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Fax | 714-539-3902
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Provider Business Mailing Address
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Address Line | 9872 CHAPMAN AVE STE 201
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City | GARDEN GROVE
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State | CA
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Zip | 92841-2733
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Country | US
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Telephone | 714-873-7793
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Fax | 714-539-3902
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Authorized Official
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Title or Position | L.AC QME CMT
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Name | PROF. SAHNGJOON LEE
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Credential | L.AC QME CMT
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Telephone | 714-873-7793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28674
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 997060
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC11269
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License Number State | CA
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