MEDICARE: SHANGPENG SI 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	AC16142	CA

General Provider Information

NPI Number	:	1962803874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANGPENG SI L.AC.

Provider Business Mailing Address
First Line	:	2124 PARK AVE APT 40
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-1322
Country	:	US
Telephone Number	:	408-398-0132
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 PARK AVE APT 40
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-1322
Country	:	US
Telephone Number	:	408-398-0132
Fax Number	:

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

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	09/10/2014

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Directions to “ SHANGPENG SI L.AC.” Practice Location

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