MEDICARE: MR. MIN LI DAO LIANG L AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC6666	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC0066660	OTHER	CA	MEDI-CAL ID NUMBER

General Provider Information

NPI Number	:	1114038932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIN LI DAO LIANG L AC.

Provider Business Mailing Address
First Line	:	890 JACKSON ST STE 101
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4848
Country	:	US
Telephone Number	:	415-982-1898
Fax Number	:	415-333-7138

Provider Business Practice Location Address
First Line	:	890 JACKSON ST STE 101
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4848
Country	:	US
Telephone Number	:	415-982-1898
Fax Number	:	415-333-7138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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