Healthcare Provider Details

I. General information

NPI: 1366592016
Provider Name (Legal Business Name): KELLY FRANCIS LOUIS LEGASSIC L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SHOTWELL ST
SAN FRANCISCO CA
94110-4015
US

IV. Provider business mailing address

1055 SHOTWELL STREET
SAN FRANCISCO CA
94110-4015
US

V. Phone/Fax

Practice location:
  • Phone: 415-309-4965
  • Fax:
Mailing address:
  • Phone: 415-309-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 9063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: