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General NPI Number Information
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NPI Number | 1194012013
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Entity Type | Organization
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Legal Business Name | PAN ACUPUNCTURE & HERB
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 6049 DOUGLAS BLVD STE 22
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City | GRANITE BAY
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State | CA
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Zip | 95746-6275
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Country | US
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Telephone | 916-784-1808
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Fax |
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Provider Business Mailing Address
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Address Line | 6049 DOUGLAS BLVD STE 22
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City | GRANITE BAY
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State | CA
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Zip | 95746-6275
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Country | US
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Telephone | 916-784-1808
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LIN PAN
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Credential |
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Telephone | 916-784-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC10224
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License Number State | CA
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