Provider Demographics
NPI:1053748988
Name:FOREST MASSAGE
Entity type:Organization
Organization Name:FOREST MASSAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-595-0201
Mailing Address - Street 1:24531 TRABUCO RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2162
Mailing Address - Country:US
Mailing Address - Phone:949-595-0201
Mailing Address - Fax:
Practice Address - Street 1:24531 TRABUCO RD STE C
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2162
Practice Address - Country:US
Practice Address - Phone:949-595-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA14841171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty