Life Acumed Spa

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

LIFE ACUMED SPA

Practice address

146 W 25TH Ave.
San Mateo, CA 94403-2208

Phone

(650) 458-3391

NPI assigned

Nov 26, 2018

Organization subpart

Yes

Parent organization

LIFE ACUMED SPA INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lisa Jeong, DAOM

Title

President

Phone

(650) 458-3391

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Life Acumed Spa

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543190400000",
    "number": "1114496809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 W 25TH AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944032208",
            "telephone_number": "650-458-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 W 25TH AVE.",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944032208",
            "telephone_number": "650-458-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE ACUMED SPA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE ACUMED SPA INC.",
        "enumeration_date": "2018-11-26",
        "last_updated": "2018-11-26",
        "status": "A",
        "authorized_official_last_name": "JEONG",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-458-3391",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DAOM"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "46-2930319",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Health Service Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.