Individual
DAL S SEO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC.
Contact information
Practice address
715 S EUCLID ST, FULLERTON, CA 92832-2611
(714) 213-8426
Mailing address
715 S EUCLID ST, FULLERTON, CA 92832-2611
(714) 213-8426
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC15525
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC15525
ACUPUNCTURE
CA
Enumeration date
11/30/2017
Last updated
06/16/2018
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