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General NPI Number Information
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NPI Number | 1679039879
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH INTEGRATIVE CHINESE MEDICINE
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 238 S ARROYO PKWY UNIT 140
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City | PASADENA
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State | CA
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Zip | 91105-4190
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Country | US
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Telephone | 626-817-2896
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 93838
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City | PASADENA
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State | CA
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Zip | 91109-3838
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Country | US
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Telephone | 626-817-2896
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Fax |
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Authorized Official
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Title or Position | DR. / PRESIDENT
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Name | TAO KWAN
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Credential | PHD, LAC, DIPL.O.M.
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Telephone | 626-817-2896
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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 |
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License Number State |
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