Healthcare Provider Details

I. General information

NPI: 1295047256
Provider Name (Legal Business Name): JANE KANG L.AC., C.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PICARDO RNCH
PACIFICA CA
94044-3701
US

IV. Provider business mailing address

1 PICARDO RNCH
PACIFICA CA
94044-3701
US

V. Phone/Fax

Practice location:
  • Phone: 415-939-4426
  • Fax:
Mailing address:
  • Phone: 415-939-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: