Provider Demographics
NPI:1972904258
Name:PLUM FAMILEE ACUPUNCTURE
Entity type:Organization
Organization Name:PLUM FAMILEE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOON
Authorized Official - Middle Name:MIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-340-5133
Mailing Address - Street 1:18102 IRVINE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3424
Mailing Address - Country:US
Mailing Address - Phone:714-340-5133
Mailing Address - Fax:
Practice Address - Street 1:18102 IRVINE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3424
Practice Address - Country:US
Practice Address - Phone:714-340-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty