MEDICARE: RAN ZHAO LAC

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	AC5395	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC5395	OTHER	CA	LAC

General Provider Information

NPI Number	:	1811014848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAN ZHAO LAC

Provider Business Mailing Address
First Line	:	16028 GALE AVE
Second Line	:
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-1605
Country	:	US
Telephone Number	:	626-336-7605
Fax Number	:	626-336-5605

Provider Business Practice Location Address
First Line	:	16028 GALE AVE
Second Line	:
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-1605
Country	:	US
Telephone Number	:	626-336-7605
Fax Number	:	626-336-5605

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/09/2007

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Directions to “ RAN ZHAO LAC” Practice Location

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