Provider Demographics
NPI:1205032042
Name:HAPPY LIFE CLINIC
Entity Type:Organization
Organization Name:HAPPY LIFE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIAJIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-401-0787
Mailing Address - Street 1:10728 RAMONA BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2601
Mailing Address - Country:US
Mailing Address - Phone:626-401-0787
Mailing Address - Fax:626-401-0879
Practice Address - Street 1:10728 RAMONA BLVD STE E
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2601
Practice Address - Country:US
Practice Address - Phone:626-401-0787
Practice Address - Fax:626-401-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AC 5271171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0052710Medicaid