Provider Demographics
NPI:1689086993
Name:BODY-MIND ACUPUNCTURE
Entity Type:Organization
Organization Name:BODY-MIND ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOTIKA
Authorized Official - Middle Name:HUY
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-200-8817
Mailing Address - Street 1:9409 POINSETTIA AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2268
Mailing Address - Country:US
Mailing Address - Phone:714-200-8817
Mailing Address - Fax:
Practice Address - Street 1:9409 POINSETTIA AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2268
Practice Address - Country:US
Practice Address - Phone:714-200-8817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15419171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty