Healthcare Provider Details

I. General information

NPI: 1568541357
Provider Name (Legal Business Name): TIMOTHY KUAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 S DORA ST
UKIAH CA
95482-5710
US

IV. Provider business mailing address

813 S DORA ST
UKIAH CA
95482-5710
US

V. Phone/Fax

Practice location:
  • Phone: 707-468-0700
  • Fax: 707-468-4359
Mailing address:
  • Phone: 707-468-0700
  • Fax: 707-468-4359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCK2224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: