Provider Demographics
NPI:1407148117
Name:FOLSOM CHINESE ACUPUNCTURE CENTER
Entity Type:Organization
Organization Name:FOLSOM CHINESE ACUPUNCTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:L AC, PHD
Authorized Official - Phone:916-984-6608
Mailing Address - Street 1:1671 CREEKSIDE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3890
Mailing Address - Country:US
Mailing Address - Phone:916-984-6608
Mailing Address - Fax:916-984-3809
Practice Address - Street 1:1671 CREEKSIDE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3890
Practice Address - Country:US
Practice Address - Phone:916-984-6608
Practice Address - Fax:916-984-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty