Healthcare Provider Details

I. General information

NPI: 1053523258
Provider Name (Legal Business Name): GAOPING GEDDES L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 W MACARTHUR BLVD
OAKLAND CA
94609-2808
US

IV. Provider business mailing address

PO BOX 11430
OAKLAND CA
94611-0430
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-8893
  • Fax: 510-547-4893
Mailing address:
  • Phone: 510-547-8893
  • Fax: 510-547-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: