Provider Demographics
NPI:1538623848
Name:WELLNESS HEAVEN
Entity type:Organization
Organization Name:WELLNESS HEAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUNSOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-638-5071
Mailing Address - Street 1:9042 GARDEN GROVE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:GARDEN GOVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1370
Mailing Address - Country:US
Mailing Address - Phone:714-638-5071
Mailing Address - Fax:
Practice Address - Street 1:9042 GARDEN GROVE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:GARDEN GOVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1370
Practice Address - Country:US
Practice Address - Phone:714-638-5071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESSHAVEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-31
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty