Healthcare Provider Details

I. General information

NPI: 1972015451
Provider Name (Legal Business Name): ALICE LUCILLE DEYOUNG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICE LUCILLE DE YOUNG

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 DOLORES ST
SAN FRANCISCO CA
94110-1564
US

IV. Provider business mailing address

519 DOLORES ST
SAN FRANCISCO CA
94110-1564
US

V. Phone/Fax

Practice location:
  • Phone: 415-695-4094
  • Fax:
Mailing address:
  • Phone: 415-695-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: