Healthcare Provider Details

I. General information

NPI: 1811014848
Provider Name (Legal Business Name): RAN ZHAO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16028 GALE AVE
HACIENDA HTS CA
91745-1605
US

IV. Provider business mailing address

16028 GALE AVE
HACIENDA HTS CA
91745-1605
US

V. Phone/Fax

Practice location:
  • Phone: 626-336-7605
  • Fax: 626-336-5605
Mailing address:
  • Phone: 626-336-7605
  • Fax: 626-336-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: