Provider Demographics
NPI:1639356710
Name:LIVE WELL CHINESE MEDICINE
Entity Type:Organization
Organization Name:LIVE WELL CHINESE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST & HERBALIST
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-235-2710
Mailing Address - Street 1:1932 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3961
Mailing Address - Country:US
Mailing Address - Phone:415-235-2710
Mailing Address - Fax:
Practice Address - Street 1:2041 PIONEER CT
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1786
Practice Address - Country:US
Practice Address - Phone:650-525-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11878171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ50676YOtherBLUE SHIELD OF CALIFORNIA