Provider Demographics
NPI:1316314974
Name:COASTAL ACUPUNCTURE & NATURAL HEALTH CENTER
Entity type:Organization
Organization Name:COASTAL ACUPUNCTURE & NATURAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:949-646-4325
Mailing Address - Street 1:1831 ORANGE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2839
Mailing Address - Country:US
Mailing Address - Phone:949-646-4325
Mailing Address - Fax:949-646-4313
Practice Address - Street 1:1831 ORANGE AVE STE E
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2839
Practice Address - Country:US
Practice Address - Phone:949-646-4325
Practice Address - Fax:949-646-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-29
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9786171100000X
CAAC16641171100000X
CAND82175F00000X
CAND228175F00000X
CAAC8700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty