MEDICARE: CAROL JAN LIAN 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	AC13172	CA

General Provider Information

NPI Number	:	1952632655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL JAN LIAN L.AC

Provider Business Mailing Address
First Line	:	22706 ASPAN ST STE 504
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-1603
Country	:	US
Telephone Number	:	949-454-2820
Fax Number	:	949-415-2214

Provider Business Practice Location Address
First Line	:	22706 ASPAN ST STE 504
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-1603
Country	:	US
Telephone Number	:	949-454-2820
Fax Number	:	949-415-2214

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

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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Directions to “ CAROL JAN LIAN L.AC” Practice Location

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