CA Wall License 857 Information
| Name | Hisayo Hatakeyama |
| License Number | 857 |
| Individual or Organization | O |
| Address | 11100 Warner Ave
Fountain Valley, CA 92708 |
| County | Orange |
| License Status | Active |
| License Original Issue Date | 4/6/2005 |
| License Expiration Date | 1/31/2023 |
| License Type | Wall License |
| Agency | Acupuncture Board |