Healthcare Provider Details

I. General information

NPI: 1902317647
Provider Name (Legal Business Name): CANAAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5658 RAVENSPUR DR UNIT 305
RANCHO PALOS VERDES CA
90275-3545
US

IV. Provider business mailing address

PO BOX 4362
PALOS VERDES PENINSULA CA
90274-9587
US

V. Phone/Fax

Practice location:
  • Phone: 310-736-5258
  • Fax:
Mailing address:
  • Phone: 424-262-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15769
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number38192
License Number StateCA

VIII. Authorized Official

Name: ALLAN KU
Title or Position: PRESIDENT
Credential:
Phone: 424-262-1866