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General NPI Number Information
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NPI Number | 1669883187
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Entity Type | Organization
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Legal Business Name | NEW LIFE ACUPUNCTURE & HERB CENTER, INC.
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 507 MISSION ST
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3035
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Country | US
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Telephone | 626-340-1489
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Fax |
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Provider Business Mailing Address
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Address Line | 3453 MARY ANN ST
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City | LA CRESCENTA
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State | CA
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Zip | 91214-2537
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Country | US
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Telephone | 626-340-1489
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | FANJIE MENG
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Credential | L. AC., D.O.M.
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Telephone | 626-340-1489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 12237
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License Number State | CA
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