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General NPI Number Information
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NPI Number | 1346734001
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Entity Type | Individual
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Provider Name | STEPHANIE X GONG LAC
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Gender | Female
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Dates
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Enumeration Date | 06/17/2018
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Last Update Date | 06/17/2018
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Provider Practice Location Address
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Address Line | 4080 EAST AVE
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City | LIVERMORE
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State | CA
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Zip | 94550-4941
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Country | US
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Telephone | 925-606-6013
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Fax |
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Provider Business Mailing Address
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Address Line | 6276 CAMINO DEL LAGO
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City | PLEASANTON
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State | CA
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Zip | 94566-8647
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Country | US
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Telephone | 925-895-8395
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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 | 18004
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License Number State | CA
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