Healthcare Provider Details

I. General information

NPI: 1427834647
Provider Name (Legal Business Name): SAMANTHA GAH-MUN LAI L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 CURTIS ST
BERKELEY CA
94702-1816
US

IV. Provider business mailing address

2132 CURTIS ST
BERKELEY CA
94702-1816
US

V. Phone/Fax

Practice location:
  • Phone: 206-992-8818
  • Fax:
Mailing address:
  • Phone: 206-992-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: