Provider Demographics
NPI:1457645814
Name:GOLDEN LIFE NATURAL HERBS, INC
Entity Type:Organization
Organization Name:GOLDEN LIFE NATURAL HERBS, INC
Other - Org Name:ADVANCED ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:THUY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-386-2404
Mailing Address - Street 1:10900 WESTMINSTER AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4918
Mailing Address - Country:US
Mailing Address - Phone:714-386-2404
Mailing Address - Fax:714-363-5544
Practice Address - Street 1:10900 WESTMINSTER AVE STE 8
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4918
Practice Address - Country:US
Practice Address - Phone:714-386-2404
Practice Address - Fax:714-363-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9634171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC009634Medicaid