Provider Demographics
NPI:1003122631
Name:DAE SANG ACUPUNCTURE CLINIC, INC.
Entity Type:Organization
Organization Name:DAE SANG ACUPUNCTURE CLINIC, INC.
Other - Org Name:ALIVE ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, PHD
Authorized Official - Phone:949-769-3384
Mailing Address - Street 1:33 CREEK RD STE 270
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7707
Mailing Address - Country:US
Mailing Address - Phone:949-769-3384
Mailing Address - Fax:949-608-1924
Practice Address - Street 1:33 CREEK RD STE 270
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7707
Practice Address - Country:US
Practice Address - Phone:949-769-3384
Practice Address - Fax:949-608-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty