=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205146180
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIRANDA TANG L.AC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2010
-----------------------------------------------------
Last Update Date | 02/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 CALIFORNIA ST SUITE 100
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94118-1863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-938-7616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 632 CALLIPPE CT
-----------------------------------------------------
City | BRISBANE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94005-1247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-938-7616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC13441
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------