Provider Demographics
NPI:1922468552
Name:LIFELINE ACUPUNCTURE & HERBS CLINIC
Entity Type:Organization
Organization Name:LIFELINE ACUPUNCTURE & HERBS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HONGJOON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC MS
Authorized Official - Phone:530-756-1445
Mailing Address - Street 1:635 ANDERSON RD
Mailing Address - Street 2:SUITE 12A
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3505
Mailing Address - Country:US
Mailing Address - Phone:530-756-1445
Mailing Address - Fax:530-756-1450
Practice Address - Street 1:6728 FAIR OAKS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3827
Practice Address - Country:US
Practice Address - Phone:916-589-7020
Practice Address - Fax:916-979-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty