Provider Demographics
NPI:1811014848
Name:ZHAO, RAN (LAC)
Entity Type:Individual
Prefix:
First Name:RAN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16028 GALE AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1605
Mailing Address - Country:US
Mailing Address - Phone:626-336-7605
Mailing Address - Fax:626-336-5605
Practice Address - Street 1:16028 GALE AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1605
Practice Address - Country:US
Practice Address - Phone:626-336-7605
Practice Address - Fax:626-336-5605
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5395171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC5395OtherLAC
CAAC0053950Medicaid