Provider Demographics
NPI:1114150471
Name:COWAN, KIRSTEN (LAC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 PIEDMONT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4766
Mailing Address - Country:US
Mailing Address - Phone:510-597-9923
Mailing Address - Fax:
Practice Address - Street 1:4341 PIEDMONT AVE STE 202
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4766
Practice Address - Country:US
Practice Address - Phone:510-597-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12723171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist