Provider Demographics
NPI:1578197950
Name:CORNERSTONE ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:CORNERSTONE ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-424-6430
Mailing Address - Street 1:150 LAGUNA RD STE A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3615
Mailing Address - Country:US
Mailing Address - Phone:949-424-6430
Mailing Address - Fax:949-612-0010
Practice Address - Street 1:150 LAGUNA RD STE A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3615
Practice Address - Country:US
Practice Address - Phone:949-424-6430
Practice Address - Fax:949-612-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA188PUHSAMedicaid