Provider Demographics
NPI:1346414844
Name:BETHEL LIGHT CORPORATION
Entity Type:Organization
Organization Name:BETHEL LIGHT CORPORATION
Other - Org Name:DBA BEACH ACUPUCNTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNGHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIK
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:714-821-4823
Mailing Address - Street 1:408 S BEACH BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1864
Mailing Address - Country:US
Mailing Address - Phone:714-821-4823
Mailing Address - Fax:714-821-4825
Practice Address - Street 1:408 S BEACH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1864
Practice Address - Country:US
Practice Address - Phone:714-821-4823
Practice Address - Fax:714-821-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty