Healthcare Provider Details

I. General information

NPI: 1629783618
Provider Name (Legal Business Name): JOSEPH KIE WEISSBUCH L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 ELLERHORST AVE
EL CERRITO CA
94530-1427
US

IV. Provider business mailing address

2610 ELLERHORST AVE
EL CERRITO CA
94530-1427
US

V. Phone/Fax

Practice location:
  • Phone: 415-717-7979
  • Fax:
Mailing address:
  • Phone: 415-717-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19537
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number51197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: