Provider Demographics
NPI:1073919676
Name:TAN, LUCY
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 HUMMINGBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4824
Mailing Address - Country:US
Mailing Address - Phone:916-897-3635
Mailing Address - Fax:
Practice Address - Street 1:2003 OPPORTUNITY DR
Practice Address - Street 2:SUITE 10
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3008
Practice Address - Country:US
Practice Address - Phone:916-897-3635
Practice Address - Fax:916-256-4464
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16261171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist