# EBENEZER WELLNESS CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114339272
- **Authorized official:** JUNGHEE KIM L.AC (VICE PRESIDENT)
- **Authorized official phone:** (714) 618-3942

## Contact information

- **Practice address:** 16261 LAGUNA CANYON RD, SUITE 100, IRVINE, CA 92618-3608
- **Practice address phone:** (714) 636-3886
- **Mailing address:** 16261 LAGUNA CANYON RD, SUITE 100, IRVINE, CA 92618-3608
- **Mailing address phone:** (714) 636-3886

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A86714 | CA | Yes |

## Other

- **Enumeration date:** 05/23/2014
- **Last updated:** 05/23/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A86714 | CA MEDICAL BOARD | CA |