Healthcare Provider Details

I. General information

NPI: 1144361270
Provider Name (Legal Business Name): STEPHANIE ANN LUM L.AC.,R.C.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 03/09/2021
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 IRWIN ST
SAN RAFAEL CA
94901-3317
US

IV. Provider business mailing address

28 LAWRENCE DR
NOVATO CA
94945-3303
US

V. Phone/Fax

Practice location:
  • Phone: 415-459-2245
  • Fax: 415-459-8938
Mailing address:
  • Phone: 415-892-3402
  • Fax: 415-459-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCJ2590
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number8754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: