Provider Demographics
NPI:1588062061
Name:PANACURE.INC
Entity type:Organization
Organization Name:PANACURE.INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:L.AC QME CMT
Authorized Official - Prefix:PROF
Authorized Official - First Name:SAHNGJOON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC QME CMT
Authorized Official - Phone:714-873-7793
Mailing Address - Street 1:9872 CHAPMAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2733
Mailing Address - Country:US
Mailing Address - Phone:714-873-7793
Mailing Address - Fax:714-539-3902
Practice Address - Street 1:9872 CHAPMAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2733
Practice Address - Country:US
Practice Address - Phone:714-873-7793
Practice Address - Fax:714-539-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28674174400000X
CA997060174400000X
CAAC11269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC11269OtherCALIFORNIA