Healthcare Provider Details

I. General information

NPI: 1699153817
Provider Name (Legal Business Name): KYLE HARTMAN L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MILLER AVE #104
MILL VALLEY CA
94941-2817
US

IV. Provider business mailing address

2025 SHORELINE HWY
MUIR BEACH CA
94965-9728
US

V. Phone/Fax

Practice location:
  • Phone: 484-725-2385
  • Fax:
Mailing address:
  • Phone: 415-383-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: