MEDICARE: NOOSHA KAHALI 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	225700000X	Massage Therapist	106424	CA
2	171100000X	Acupuncturist	18027	CA

General Provider Information

NPI Number	:	1932689791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOOSHA KAHALI LAC

Provider Business Mailing Address
First Line	:	15 CROXTON AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5728
Country	:	US
Telephone Number	:	510-654-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 CROXTON AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5728
Country	:	US
Telephone Number	:	510-468-9802
Fax Number	:

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

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	11/19/2018

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Directions to “ NOOSHA KAHALI LAC” Practice Location

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