Healthcare Provider Details

I. General information

NPI: 1750616926
Provider Name (Legal Business Name): KAREN CHAN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 6TH ST
BERKELEY CA
94710-2219
US

IV. Provider business mailing address

2228 6TH ST
BERKELEY CA
94710-2219
US

V. Phone/Fax

Practice location:
  • Phone: 510-540-6267
  • Fax: 510-540-6212
Mailing address:
  • Phone: 510-540-6267
  • Fax: 510-540-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA13343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: