Provider Demographics
NPI:1518357243
Name:SAM HAE, INC
Entity Type:Organization
Organization Name:SAM HAE, INC
Other - Org Name:SAM HAE ACUPUNCTURE HERB CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUK SANG
Authorized Official - Middle Name:
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTUREIST
Authorized Official - Phone:213-505-2828
Mailing Address - Street 1:1437 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-887-7575
Mailing Address - Fax:323-887-7575
Practice Address - Street 1:1437 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-887-7575
Practice Address - Fax:323-887-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10295171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty