Provider Demographics
NPI:1083347579
Name:TIN, PEARL (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:
Last Name:TIN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-0515
Mailing Address - Country:US
Mailing Address - Phone:408-391-4178
Mailing Address - Fax:
Practice Address - Street 1:173 SUN BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2265
Practice Address - Country:US
Practice Address - Phone:408-391-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist