MEDICARE: FOUNTYN ACUPUNCTURE INC

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	:	1336737261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTYN ACUPUNCTURE INC

Provider Business Mailing Address
First Line	:	2583 HAMPTON AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-2539
Country	:	US
Telephone Number	:	917-670-4107
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 CONNECTICUT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-2402
Country	:	US
Telephone Number	:	917-670-4107
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	RACHELE LAM
Credential	:	DACM, LAC
Telephone Number	:	917-670-4107

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	11/03/2021

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