Healthcare Provider Details

I. General information

NPI: 1336737261
Provider Name (Legal Business Name): FOUNTYN ACUPUNCTURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 CONNECTICUT ST
SAN FRANCISCO CA
94107-2402
US

IV. Provider business mailing address

2583 HAMPTON AVE
REDWOOD CITY CA
94061-2539
US

V. Phone/Fax

Practice location:
  • Phone: 917-670-4107
  • Fax:
Mailing address:
  • Phone: 917-670-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: RACHELE LAM
Title or Position: ACUPUNCTURIST
Credential: DACM, LAC
Phone: 917-670-4107