Provider Demographics
NPI:1669848479
Name:UNION ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:UNION ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SANG
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:951-833-4699
Mailing Address - Street 1:32245 MISSION TRL
Mailing Address - Street 2:STE. D6
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4528
Mailing Address - Country:US
Mailing Address - Phone:951-674-8683
Mailing Address - Fax:951-674-1763
Practice Address - Street 1:32245 MISSION TRL
Practice Address - Street 2:STE. D6
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4528
Practice Address - Country:US
Practice Address - Phone:951-674-8683
Practice Address - Fax:951-674-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-15
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty