=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083756662
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIYOKO MIYATA LAC DNBAO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 05/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2233 IRVING ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-753-3300
-----------------------------------------------------
Fax | 415-753-3309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2233 IRVING ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-753-3300
-----------------------------------------------------
Fax | 415-753-3309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC5834
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------