Healthcare Provider Details

I. General information

NPI: 1447451224
Provider Name (Legal Business Name): LI HAN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16388 COLIMA RD STE 108
HACIENDA HTS CA
91745-5523
US

IV. Provider business mailing address

17040 COLIMA RD APT 149
HACIENDA HTS CA
91745-6721
US

V. Phone/Fax

Practice location:
  • Phone: 909-576-1108
  • Fax:
Mailing address:
  • Phone: 909-576-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: