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General NPI Number Information
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NPI Number | 1720349921
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Entity Type | Organization
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Legal Business Name | FIVE ELEMENT CARE
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 6540 LUSK BLVD #C-144
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City | SAN DIEGO
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State | CA
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Zip | 92121-2767
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Country | US
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Telephone | 858-658-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 6540 LUSK BLVD #C-144
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City | SAN DIEGO
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State | CA
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Zip | 92121-2767
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Country | US
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Telephone | 858-658-9980
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YOUNG SHIG O
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Credential | L.AC
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Telephone | 858-658-9980
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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 | AC10624
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License Number State | CA
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