Provider Demographics
NPI:1144922519
Name:VITA ACUPUNCTURE & HERBS
Entity type:Organization
Organization Name:VITA ACUPUNCTURE & HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SE YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-655-1183
Mailing Address - Street 1:910 W SAN MARCOS BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1116
Mailing Address - Country:US
Mailing Address - Phone:442-655-1183
Mailing Address - Fax:
Practice Address - Street 1:910 W SAN MARCOS BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1116
Practice Address - Country:US
Practice Address - Phone:442-655-1183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty