Provider Demographics
NPI:1508388463
Name:FORMOSA WELLNESS CENTER INC
Entity Type:Organization
Organization Name:FORMOSA WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUHAO
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:909-455-7272
Mailing Address - Street 1:1300 E MAIN ST STE 209F
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4150
Mailing Address - Country:US
Mailing Address - Phone:909-455-7272
Mailing Address - Fax:
Practice Address - Street 1:1300 E MAIN ST STE 209F
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4150
Practice Address - Country:US
Practice Address - Phone:909-455-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32674111N00000X
CAAC15603171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty