Healthcare Provider Details

I. General information

NPI: 1740426253
Provider Name (Legal Business Name): JAPANESE ACUPUNCTURE KEI'S CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROLLINS RD STE 109
MILLBRAE CA
94030-3128
US

IV. Provider business mailing address

10 ROLLINS RD STE 109
MILLBRAE CA
94030-3128
US

V. Phone/Fax

Practice location:
  • Phone: 650-697-3123
  • Fax:
Mailing address:
  • Phone: 650-697-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7521
License Number StateCA

VIII. Authorized Official

Name: DR. KEI KUROTANI
Title or Position: OWNER
Credential: PH.D, L.AC.
Phone: 650-697-3123