Provider Demographics
NPI:1285317420
Name:AGE WELL ACUPUNCTURE & MED SPA INC
Entity type:Organization
Organization Name:AGE WELL ACUPUNCTURE & MED SPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:YOUNGSOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-505-1724
Mailing Address - Street 1:26732 CROWN VALLEY PKWY STE 572
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-7305
Mailing Address - Country:US
Mailing Address - Phone:213-505-1724
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 572
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-7305
Practice Address - Country:US
Practice Address - Phone:213-505-1724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty