Healthcare Provider Details

I. General information

NPI: 1033037593
Provider Name (Legal Business Name): SOTHEARAVISAL TOUNVANN L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PLEASANT ST APT 400
MALDEN MA
02148-3083
US

IV. Provider business mailing address

1929 MIDDLESEX ST APT 2
LOWELL MA
01851-1007
US

V. Phone/Fax

Practice location:
  • Phone: 617-866-7688
  • Fax:
Mailing address:
  • Phone: 978-429-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number854546
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: