Provider Demographics
NPI:1083131080
Name:TRANSFORM ACUPUNCTURE INC
Entity Type:Organization
Organization Name:TRANSFORM ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOANNE
Authorized Official - Middle Name:MY
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:626-975-5022
Mailing Address - Street 1:12832 GARDEN GROVE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2014
Mailing Address - Country:US
Mailing Address - Phone:714-467-0293
Mailing Address - Fax:714-467-0298
Practice Address - Street 1:12832 GARDEN GROVE BLVD STE B
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2014
Practice Address - Country:US
Practice Address - Phone:714-467-0293
Practice Address - Fax:714-467-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11863171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225206972OtherACUPUNCTURE