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General NPI Number Information
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NPI Number | 1346500790
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Entity Type | Individual
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Provider Name | DAPHNE SU LAC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2012
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Last Update Date | 05/19/2012
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Provider Practice Location Address
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Address Line | 3730 N JOSEY LN STE 122
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City | CARROLLTON
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State | TX
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Zip | 75007-2439
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Country | US
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Telephone | 972-836-8615
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Fax |
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Provider Business Mailing Address
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Address Line | 8512 KENNING CT
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City | PLANO
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State | TX
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Zip | 75024-7301
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Country | US
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Telephone | 469-328-3680
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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 | AC01341
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License Number State | TX
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