Provider Demographics
NPI:1538309893
Name:SHI, NIAN PENG (LAC, PH D)
Entity Type:Individual
Prefix:DR
First Name:NIAN PENG
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:LAC, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 ADDISON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1141
Mailing Address - Country:US
Mailing Address - Phone:510-704-8888
Mailing Address - Fax:510-704-1875
Practice Address - Street 1:1919 ADDISON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1141
Practice Address - Country:US
Practice Address - Phone:510-704-8888
Practice Address - Fax:510-704-1875
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist