Provider Demographics
NPI:1396100137
Name:DNA HOLISTIC ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:DNA HOLISTIC ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-828-2345
Mailing Address - Street 1:2660 W WOODLAND DR STE 130
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2618
Mailing Address - Country:US
Mailing Address - Phone:714-828-2345
Mailing Address - Fax:714-828-2393
Practice Address - Street 1:2660 W WOODLAND DR STE 130
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2618
Practice Address - Country:US
Practice Address - Phone:714-828-2345
Practice Address - Fax:714-828-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty