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NPI Code Detail

MEDICARE: MICHAEL VAN INC.

MEDICARE: MICHAEL VAN INC.
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
1171100000XAcupuncturistAC9129CA
2171100000XAcupuncturistAC9368CA

General Provider Information

NPI Number : 1740343185
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHAEL VAN INC.
Provider Business Mailing Address
First Line : 10174 INDIANA AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-5304
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10174 INDIANA AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-5304
Country : US
Telephone Number : 951-343-2848
Fax Number : 951-343-2969
Authorized Official
Title or Position : CEO
Name : DR. MICHAEL VAN
Credential : L. AC., PH. D.
Telephone Number : 951-343-2848
Provider Enumeration Date : 12/18/2006
Last Update Date : 08/22/2020

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Directions to “MICHAEL VAN INC. ” Practice Location

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