Provider Demographics
NPI:1326804519
Name:DR FAN ACUPUNCTURE CLINIC LLC
Entity Type:Organization
Organization Name:DR FAN ACUPUNCTURE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONGXIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:512-999-3990
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD STE Q2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8665
Mailing Address - Country:US
Mailing Address - Phone:512-999-3990
Mailing Address - Fax:512-520-4233
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE Q2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8665
Practice Address - Country:US
Practice Address - Phone:512-999-3990
Practice Address - Fax:512-520-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty