Healthcare Provider Details

I. General information

NPI: 1194844548
Provider Name (Legal Business Name): NHAN-ESTEBAN VILLARREAL KHUONG L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E WALNUT ST SUITE 305
PASADENA CA
91101-1676
US

IV. Provider business mailing address

711 E WALNUT ST SUITE 305
PASADENA CA
91101-1676
US

V. Phone/Fax

Practice location:
  • Phone: 310-365-8155
  • Fax:
Mailing address:
  • Phone: 310-365-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: