Healthcare Provider Details

I. General information

NPI: 1457761975
Provider Name (Legal Business Name): KATIE NGAN DC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 10/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR SUITE 308A
WALNUT CREEK CA
94596-4962
US

IV. Provider business mailing address

1844 SAN MIGUEL DR SUITE 308A
WALNUT CREEK CA
94596-4962
US

V. Phone/Fax

Practice location:
  • Phone: 925-322-1313
  • Fax:
Mailing address:
  • Phone: 925-322-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15947
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC32363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: