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General NPI Number Information
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NPI Number | 1619742004
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Entity Type | Individual
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Provider Name | KATHLEEN AUGUST LAC
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Gender | Female
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 2089 VALE RD STE 10
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City | SAN PABLO
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State | CA
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Zip | 94806-3848
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Country | US
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Telephone | 510-831-2217
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Fax |
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Provider Business Mailing Address
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Address Line | 3921A OPAL ST
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City | OAKLAND
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State | CA
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Zip | 94609-2626
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Country | US
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Telephone | 510-499-0058
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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 | 19913
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License Number State | CA
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