Healthcare Provider Details

I. General information

NPI: 1124201595
Provider Name (Legal Business Name): XIU ZHEN FANG L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 E COLORADO BLVD
PASADENA CA
91107-4311
US

IV. Provider business mailing address

4923 HALLOWELL AVE
TEMPLE CITY CA
91780-3459
US

V. Phone/Fax

Practice location:
  • Phone: 626-215-3806
  • Fax:
Mailing address:
  • Phone: 626-215-3806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 6057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: