Provider Demographics
NPI:1285464495
Name:DRAGONFAE ACUPUNCTURE & HEALING MEDICINALS
Entity type:Organization
Organization Name:DRAGONFAE ACUPUNCTURE & HEALING MEDICINALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIA HOA
Authorized Official - Middle Name:HOA
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-548-9807
Mailing Address - Street 1:14805 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5855
Mailing Address - Country:US
Mailing Address - Phone:714-548-9807
Mailing Address - Fax:
Practice Address - Street 1:15751 BROOKHURST ST STE 130
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7591
Practice Address - Country:US
Practice Address - Phone:714-548-9807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care