Healthcare Provider Details

I. General information

NPI: 1023163169
Provider Name (Legal Business Name): SEAN MICHAEL HALL L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 STUART ST
BERKELEY CA
94705-1109
US

IV. Provider business mailing address

2346 STUART ST
BERKELEY CA
94705-1109
US

V. Phone/Fax

Practice location:
  • Phone: 510-705-8755
  • Fax: 510-705-8520
Mailing address:
  • Phone: 510-705-8755
  • Fax: 510-705-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: