=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639611395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE & HEALTH ACUPUNCTURE & HERBS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2016
-----------------------------------------------------
Last Update Date | 02/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9872 CHAPMAN AVE SUITE #114
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92841-2737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-408-1169
-----------------------------------------------------
Fax | 714-408-1169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 S FLOWER ST UNIT 16
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-3458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-434-1598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSANNAH KIM KANG
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 213-434-1598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC17274
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------