Provider Demographics
NPI:1104215326
Name:PAIN RELIEF ACUPUNCTURE
Entity Type:Organization
Organization Name:PAIN RELIEF ACUPUNCTURE
Other - Org Name:PATRICK BRENT KING L.AC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:760-799-3682
Mailing Address - Street 1:PO BOX 11286
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5024
Mailing Address - Country:US
Mailing Address - Phone:760-799-3682
Mailing Address - Fax:
Practice Address - Street 1:1110 ROOSEVELT
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3686
Practice Address - Country:US
Practice Address - Phone:760-799-3682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15851171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty