Healthcare Provider Details

I. General information

NPI: 1457429888
Provider Name (Legal Business Name): AFSHIN MOKHTARI L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 CASTRO ST STE 4
MOUNTAIN VIEW CA
94041-2019
US

IV. Provider business mailing address

264 37TH AVE
SAN MATEO CA
94403-4325
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-2378
  • Fax:
Mailing address:
  • Phone: 650-346-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: