Provider Demographics
NPI:1790483873
Name:MYLIFE ACUCENTER, INC.
Entity Type:Organization
Organization Name:MYLIFE ACUCENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GUANG DI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:909-979-4568
Mailing Address - Street 1:11422 AUTUMN SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-5035
Mailing Address - Country:US
Mailing Address - Phone:909-979-4568
Mailing Address - Fax:888-691-2206
Practice Address - Street 1:16486 BERNARDO CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2519
Practice Address - Country:US
Practice Address - Phone:626-765-5678
Practice Address - Fax:888-691-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty