=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922166883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEI KUROTANI L.AC, PH.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 ROLLINS RD SUITE 109
-----------------------------------------------------
City | MILLBRAE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94030-3130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-697-3123
-----------------------------------------------------
Fax | 650-697-3077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 ROLLINS RD SUITE 109
-----------------------------------------------------
City | MILLBRAE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94030-3130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-697-3123
-----------------------------------------------------
Fax | 650-697-3077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC7521
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------