Provider Demographics
NPI:1982811717
Name:MAH, FRIEDA (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:FRIEDA
Middle Name:
Last Name:MAH
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:IJUEN
Other - Middle Name:FRIEDA
Other - Last Name:MAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:11127 BINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6424
Mailing Address - Country:US
Mailing Address - Phone:562-440-1589
Mailing Address - Fax:
Practice Address - Street 1:4902 IRVINE CENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3305
Practice Address - Country:US
Practice Address - Phone:949-407-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11030171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist