Provider Demographics
NPI:1285844027
Name:PURE BALANCE HEALING ART CENTER
Entity Type:Organization
Organization Name:PURE BALANCE HEALING ART CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EUNGSOON
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, PHD
Authorized Official - Phone:949-249-2839
Mailing Address - Street 1:30110 CROWN VALLEY PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2043
Mailing Address - Country:US
Mailing Address - Phone:949-249-2839
Mailing Address - Fax:949-249-2839
Practice Address - Street 1:30110 CROWN VALLEY PKWY STE 107
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2043
Practice Address - Country:US
Practice Address - Phone:949-249-2839
Practice Address - Fax:949-249-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10097171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty