Healthcare Provider Details

I. General information

NPI: 1104267590
Provider Name (Legal Business Name): DAWN TSE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 REED ST
MILL VALLEY CA
94941-4443
US

IV. Provider business mailing address

231 REED ST
MILL VALLEY CA
94941-4443
US

V. Phone/Fax

Practice location:
  • Phone: 415-717-1478
  • Fax:
Mailing address:
  • Phone: 415-717-1478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: