Provider Demographics
NPI:1033722749
Name:LIFE CLINIC LLC
Entity Type:Organization
Organization Name:LIFE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDCINE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YORIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBONOYA
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:702-462-9258
Mailing Address - Street 1:1223 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1736
Mailing Address - Country:US
Mailing Address - Phone:702-462-9258
Mailing Address - Fax:
Practice Address - Street 1:1223 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1736
Practice Address - Country:US
Practice Address - Phone:702-462-9258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty