MEDICARE: DR. SEPIDEH LACKPOUR L.AC. PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC5194	CA

General Provider Information

NPI Number	:	1699846956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEPIDEH LACKPOUR L.AC. PH.D.

Provider Business Mailing Address
First Line	:	827 DEEP VALLEY DR
Second Line	:	SUITE #103
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3647
Country	:	US
Telephone Number	:	310-265-9588
Fax Number	:	310-265-9584

Provider Business Practice Location Address
First Line	:	827 DEEP VALLEY DR
Second Line	:	SUITE #103
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3647
Country	:	US
Telephone Number	:	310-265-9588
Fax Number	:	310-265-9584

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	03/18/2010

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Directions to “ DR. SEPIDEH LACKPOUR L.AC. PH.D.” Practice Location

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