Provider Demographics
NPI:1518263011
Name:GORDON, SARA KENDALL (L AC, DAOM)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:KENDALL
Last Name:GORDON
Suffix:
Gender:F
Credentials:L AC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PROFESSIONAL CENTER PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2755
Mailing Address - Country:US
Mailing Address - Phone:415-479-2027
Mailing Address - Fax:
Practice Address - Street 1:55 PROFESSIONAL CENTER PKWY
Practice Address - Street 2:F
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2755
Practice Address - Country:US
Practice Address - Phone:415-479-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4696171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist