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General NPI Number Information
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NPI Number | 1265380737
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Entity Type | Individual
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Provider Name | KEVIN RUSSELL L.AC.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 3280 ADELINE ST
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City | BERKELEY
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State | CA
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Zip | 94703-2439
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Country | US
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Telephone | 510-387-8678
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Fax |
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Provider Business Mailing Address
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Address Line | 229 SCENIC AVE
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City | PIEDMONT
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State | CA
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Zip | 94611-3416
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Country | US
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Telephone | 510-343-4942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | AC20036
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License Number State | CA
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