Healthcare Provider Details

I. General information

NPI: 1295892362
Provider Name (Legal Business Name): SUSAN SHAO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN S.C. SHAO L.AC.

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9092 TALBERT AVE SUITE 10
FOUNTAIN VALLEY CA
92708-4452
US

IV. Provider business mailing address

9092 TALBERT AVE SUITE 10
FOUNTAIN VALLEY CA
92708-4452
US

V. Phone/Fax

Practice location:
  • Phone: 714-968-3325
  • Fax: 714-968-6656
Mailing address:
  • Phone: 714-968-3325
  • Fax: 714-968-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: