Healthcare Provider Details

I. General information

NPI: 1881978583
Provider Name (Legal Business Name): FANJIE MENG L.AC., O.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22917 SOLEDAD CANYON RD
SAUGUS CA
91350-2633
US

IV. Provider business mailing address

22917 SOLEDAD CANYON RD
SAUGUS CA
91350-2633
US

V. Phone/Fax

Practice location:
  • Phone: 661-255-1898
  • Fax:
Mailing address:
  • Phone: 661-255-1898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: