Healthcare Provider Details

I. General information

NPI: 1063580405
Provider Name (Legal Business Name): GERIE KEH L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11373 FERRARA LN
PORTER RANCH CA
91326-4154
US

IV. Provider business mailing address

11373 FERRARA LANE
PORTER RANCH CA
91326-4154
US

V. Phone/Fax

Practice location:
  • Phone: 818-576-0943
  • Fax: 818-341-3514
Mailing address:
  • Phone: 818-576-0943
  • Fax: 818-341-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 5659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: