MEDICARE: MRS. MINGZHU PEARL SUN LAC

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	0027	AZ
2	171100000X	Acupuncturist	AC5954	CA

General Provider Information

NPI Number	:	1265602403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MINGZHU PEARL SUN LAC

Provider Business Mailing Address
First Line	:	6971 W POTTER DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-9472
Country	:	US
Telephone Number	:	623-825-9381
Fax Number	:

Provider Business Practice Location Address
First Line	:	13540 W CAMINO DEL SOL
Second Line	:	SUITE 10
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-4435
Country	:	US
Telephone Number	:	623-556-9686
Fax Number	:	623-556-9686

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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