Healthcare Provider Details

I. General information

NPI: 1154717965
Provider Name (Legal Business Name): ANH NGUYEN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 SEVENTH ST
BERKELEY CA
94710-2702
US

IV. Provider business mailing address

1000 JONES ST
BERKELEY CA
94710-1520
US

V. Phone/Fax

Practice location:
  • Phone: 510-501-3518
  • Fax: 510-722-2257
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: