Healthcare Provider Details

I. General information

NPI: 1396015269
Provider Name (Legal Business Name): XIU FEN PAN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOPHIA PAN L.AC

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 SAN MIGUEL DR SUITE 203
WALNUT CREEK CA
94596
US

IV. Provider business mailing address

1930 MAGELLAN DR
OAKLAND CA
94611-2636
US

V. Phone/Fax

Practice location:
  • Phone: 925-391-0066
  • Fax: 925-940-9523
Mailing address:
  • Phone: 415-349-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: