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General NPI Number Information
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NPI Number | 1508386087
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Entity Type | Individual
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Provider Name | JOANNE KHA LAC
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Gender | Female
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1531 S NOVATO BLVD STE E
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City | NOVATO
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State | CA
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Zip | 94947-4184
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Country | US
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Telephone | 510-621-7671
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Fax | 510-201-3139
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Provider Business Mailing Address
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Address Line | 1931 TIOGA LOOP
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City | HERCULES
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State | CA
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Zip | 94547-2794
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Country | US
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Telephone | 510-621-7671
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Fax | 510-201-3139
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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 | 17603
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License Number State | CA
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