MEDICARE: MS. DAPHNE SU 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	AC01341	TX

General Provider Information

NPI Number	:	1346500790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAPHNE SU LAC

Provider Business Mailing Address
First Line	:	8512 KENNING CT
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-7301
Country	:	US
Telephone Number	:	469-328-3680
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 N JOSEY LN STE 122
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2439
Country	:	US
Telephone Number	:	972-836-8615
Fax Number	:

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

Provider Enumeration Date	:	05/19/2012
Last Update Date	:	05/19/2012

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