Healthcare Provider Details

I. General information

NPI: 1922166883
Provider Name (Legal Business Name): KEI KUROTANI L.AC, PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROLLINS RD SUITE 109
MILLBRAE CA
94030-3130
US

IV. Provider business mailing address

10 ROLLINS RD SUITE 109
MILLBRAE CA
94030-3130
US

V. Phone/Fax

Practice location:
  • Phone: 650-697-3123
  • Fax: 650-697-3077
Mailing address:
  • Phone: 650-697-3123
  • Fax: 650-697-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: