Provider Demographics
NPI:1053859991
Name:HEALING LIGHT FAMILY ACUPUNCTURE CORP.
Entity Type:Organization
Organization Name:HEALING LIGHT FAMILY ACUPUNCTURE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MUKUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-257-7622
Mailing Address - Street 1:18430 BROOKHURST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6726
Mailing Address - Country:US
Mailing Address - Phone:949-257-7622
Mailing Address - Fax:
Practice Address - Street 1:18430 BROOKHURST ST STE 102
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6726
Practice Address - Country:US
Practice Address - Phone:949-257-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 13194OtherCALIFORNIA ACUPUNCTURE BOARD