MEDICARE: DR. SARA KENDALL GORDON L. AC, DAOM

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	AC4696	CA

General Provider Information

NPI Number	:	1518263011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA KENDALL GORDON L. AC, DAOM

Provider Business Mailing Address
First Line	:	55 PROFESSIONAL CENTER PKWY
Second Line	:	SUITE F
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2755
Country	:	US
Telephone Number	:	415-479-2027
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 PROFESSIONAL CENTER PKWY
Second Line	:	F
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2755
Country	:	US
Telephone Number	:	415-479-2027
Fax Number	:

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

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	04/21/2016

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