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General NPI Number Information
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NPI Number | 1043768856
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Entity Type | Organization
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Legal Business Name | H.O.P.E. FOR HEALING INSTITUTE (A 501C3 NOT FOR PROFIT)
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 900 LARKSPUR LANDING CIR SUITE # 115
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City | LARKSPUR
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State | CA
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Zip | 94939-1757
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Country | US
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Telephone | 415-785-8652
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Fax | 415-785-8697
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Provider Business Mailing Address
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Address Line | 900 LARKSPUR LANDING CIR SUITE # 115
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City | LARKSPUR
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State | CA
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Zip | 94939-1757
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Country | US
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Telephone | 415-785-8652
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Fax | 415-785-8697
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JACQUELINE S. CHAN
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Credential | D.O.
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Telephone | 415-785-8652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 20A10041
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License Number State | CA
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