Provider Demographics
NPI:1326622580
Name:AN, STEPHEN GZ
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GZ
Last Name:AN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 WESTCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2014
Mailing Address - Country:US
Mailing Address - Phone:213-235-6273
Mailing Address - Fax:
Practice Address - Street 1:866 N VERMONT AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3587
Practice Address - Country:US
Practice Address - Phone:213-235-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist