Healthcare Provider Details

I. General information

NPI: 1508980863
Provider Name (Legal Business Name): QI HAN L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 JUDAH ST
SAN FRANCISCO CA
94122-1324
US

IV. Provider business mailing address

2858 BREAKER CIR
HAYWARD CA
94545-1349
US

V. Phone/Fax

Practice location:
  • Phone: 415-681-6598
  • Fax: 415-566-0852
Mailing address:
  • Phone: 415-681-6598
  • Fax: 415-566-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: