MEDICARE: TERESA ATANANTE KUNG L.AC.

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	AC 11714	CA

General Provider Information

NPI Number	:	1427298769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ATANANTE KUNG L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 35
Second Line	:
City	:	SAN GREGORIO
State	:	CA
Zip	:	94074-0035
Country	:	US
Telephone Number	:	650-391-7281
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 MAIN ST
Second Line	:	SUITE A , B
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1996
Country	:	US
Telephone Number	:	650-391-7281
Fax Number	:

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

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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