Provider Demographics
NPI:1740602945
Name:HARVEST HEALTH CLINIC FOR ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:HARVEST HEALTH CLINIC FOR ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNG HWA
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-564-0226
Mailing Address - Street 1:801 N TUSTIN AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3601
Mailing Address - Country:US
Mailing Address - Phone:714-564-0226
Mailing Address - Fax:888-510-0082
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-564-0226
Practice Address - Fax:888-510-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13080171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty