MEDICARE: DR. SHOSHANA LONDON DTCM, 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	20033	CA

General Provider Information

NPI Number	:	1356100127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHOSHANA LONDON DTCM, LAC

Provider Business Mailing Address
First Line	:	11264 NEWTOWN RD
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-9728
Country	:	US
Telephone Number	:	530-362-8232
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 PROVIDENCE MINE RD STE 115
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2956
Country	:	US
Telephone Number	:	530-900-4304
Fax Number	:

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

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	03/20/2024

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