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General NPI Number Information
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NPI Number | 1942655014
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE WELLNESS ACUPUNCTURE & HERBS, INC.
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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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 | 818-928-5338
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Fax |
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Provider Business Mailing Address
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Address Line | 8134 WISHING WELL LN
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City | CHINO
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State | CA
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Zip | 91708-9310
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Country | US
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Telephone | 909-800-6838
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LI HUNG LEE
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Credential |
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Telephone | 818-928-5338
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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 | AC16179
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License Number State | CA
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