MEDICARE: DR FAN ACUPUNCTURE CLINIC LLC

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

General Provider Information

NPI Number	:	1326804519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR FAN ACUPUNCTURE CLINIC LLC

Provider Business Mailing Address
First Line	:	4131 SPICEWOOD SPRINGS RD STE Q2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8665
Country	:	US
Telephone Number	:	512-999-3990
Fax Number	:	512-520-4233

Provider Business Practice Location Address
First Line	:	4131 SPICEWOOD SPRINGS RD STE Q2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8665
Country	:	US
Telephone Number	:	512-999-3990
Fax Number	:	512-520-4233

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YONGXIN FAN
Credential	:	LAC
Telephone Number	:	512-999-3990

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	05/07/2024

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