Healthcare Provider Details

I. General information

NPI: 1538309893
Provider Name (Legal Business Name): NIAN PENG SHI L..AC., PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 ADDISON ST SUITE 101
BERKELEY CA
94704-1141
US

IV. Provider business mailing address

1919 ADDISON ST SUITE 101
BERKELEY CA
94704-1141
US

V. Phone/Fax

Practice location:
  • Phone: 510-704-8888
  • Fax: 510-704-1875
Mailing address:
  • Phone: 510-704-8888
  • Fax: 510-704-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: