=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396015269
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XIU FEN PAN L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2012
-----------------------------------------------------
Last Update Date | 06/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1840 SAN MIGUEL DR SUITE 203
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-391-0066
-----------------------------------------------------
Fax | 925-940-9523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1930 MAGELLAN DR
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94611-2636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-349-1945
-----------------------------------------------------
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 | AC14378
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------