Provider Demographics
NPI:1649643784
Name:LIFE HERBS ACUPUNCTURE INC
Entity type:Organization
Organization Name:LIFE HERBS ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-700-9314
Mailing Address - Street 1:555 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 W REDONDO BEACH BLVD
Practice Address - Street 2:STE 111
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-1612
Practice Address - Country:US
Practice Address - Phone:310-756-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8057302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization