Provider Demographics
NPI:1639566474
Name:HEIN, GAYLIAN (LAC)
Entity Type:Individual
Prefix:
First Name:GAYLIAN
Middle Name:
Last Name:HEIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 OLD NEWPORT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4250
Mailing Address - Country:US
Mailing Address - Phone:714-642-4661
Mailing Address - Fax:
Practice Address - Street 1:425 OLD NEWPORT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4250
Practice Address - Country:US
Practice Address - Phone:714-642-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16529171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist