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General NPI Number Information
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NPI Number | 1871851675
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Entity Type | Organization
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Legal Business Name | SUSAN SHAO L.AC.
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 9092 TALBERT AVE #10
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4452
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Country | US
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Telephone | 714-968-3325
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Fax |
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Provider Business Mailing Address
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Address Line | 9092 TALBERT AVE #10
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4452
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Country | US
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Telephone | 714-968-3325
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Fax |
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Authorized Official
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Title or Position | OFFICER PRESIDENT & SECRETARY
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Name | SUSAN SHAO
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Credential | ACUPUNCTURIST
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Telephone | 714-968-3325
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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 | AC-2948
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License Number State | CA
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