Healthcare Provider Details

I. General information

NPI: 1497679583
Provider Name (Legal Business Name): SOPHIA CHAN L.AC., DIPL. O.M.
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: SHUFEN KAN

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CEDAR DR E
BRIARCLIFF MANOR NY
10510-2602
US

IV. Provider business mailing address

130 CEDAR DR E
BRIARCLIFF MANOR NY
10510-2602
US

V. Phone/Fax

Practice location:
  • Phone: 914-433-5662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: