Healthcare Provider Details

I. General information

NPI: 1629100045
Provider Name (Legal Business Name): FU QIAN HUANG CA LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 E BELMONT AVE
FRESNO CA
93701
US

IV. Provider business mailing address

3092 E UNIVERSITY AVE
FRESNO CA
93703
US

V. Phone/Fax

Practice location:
  • Phone: 559-441-1568
  • Fax: 559-441-1568
Mailing address:
  • Phone: 559-268-5428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: