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General NPI Number Information
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NPI Number | 1649643784
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Entity Type | Organization
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Legal Business Name | LIFE HERBS ACUPUNCTURE INC
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 555 W REDONDO BEACH BLVD STE 111
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City | GARDENA
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State | CA
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Zip | 90248-1612
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Country | US
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Telephone | 310-756-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 555 W REDONDO BEACH BLVD STE 111
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City | GARDENA
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State | CA
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Zip | 90248-1612
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | DR. DONG PARK
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Credential |
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Telephone | 213-700-9314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | AC8057
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License Number State | CA
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