MEDICARE: DR. EVIE KATAHDIN ND, 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	AC 9988	CA
2	175F00000X	Naturopath	ND 33	CA

General Provider Information

NPI Number	:	1710151915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVIE KATAHDIN ND, LAC

Provider Business Mailing Address
First Line	:	4121 WESTERLY PL
Second Line	:	SUITE 102
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2322
Country	:	US
Telephone Number	:	949-660-1399
Fax Number	:	949-660-1333

Provider Business Practice Location Address
First Line	:	4121 WESTERLY PL
Second Line	:	SUITE 102
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2322
Country	:	US
Telephone Number	:	949-660-1399
Fax Number	:	949-660-1333

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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