Healthcare Provider Details

I. General information

NPI: 1396881116
Provider Name (Legal Business Name): KEI-HANG PAK L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLBY ST STE 203A
BERKELEY CA
94705-2058
US

IV. Provider business mailing address

3000 COLBY ST STE 203A
BERKELEY CA
94705-2058
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-8477
  • Fax: 866-929-7361
Mailing address:
  • Phone: 510-845-8477
  • Fax: 866-929-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: