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General NPI Number Information
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NPI Number | 1407090988
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Entity Type | Organization
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Legal Business Name | LAUGHING BUDDHA ACUPUNCTURE
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 230 GRAND AVE. SUITE 301C
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City | OAKLAND
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State | CA
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Zip | 94610
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Country | US
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Telephone | 510-451-2577
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Fax |
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Provider Business Mailing Address
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Address Line | 381 BELMONT ST. #202
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City | OAKLAND
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State | CA
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Zip | 94610
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Country | US
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Telephone | 530-902-9854
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MS. ALYSIA DIANNE CONDON
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Credential | L.AC.
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Telephone | 530-902-9854
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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 | AC12769
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License Number State | CA
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