Provider Demographics
NPI:1851845556
Name:GOOD LIFE ACUPUNCTURE
Entity Type:Organization
Organization Name:GOOD LIFE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-530-7780
Mailing Address - Street 1:22910 CRENSHAW BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3060
Mailing Address - Country:US
Mailing Address - Phone:310-530-7780
Mailing Address - Fax:310-530-7783
Practice Address - Street 1:22910 CRENSHAW BLVD STE C
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3060
Practice Address - Country:US
Practice Address - Phone:310-530-7780
Practice Address - Fax:310-530-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty