Provider Demographics
NPI:1871851675
Name:SUSAN SHAO L.AC.
Entity Type:Organization
Organization Name:SUSAN SHAO L.AC.
Other - Org Name:SUSAN SHAO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICER PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAO
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:714-968-3325
Mailing Address - Street 1:9092 TALBERT AVE #10
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4452
Mailing Address - Country:US
Mailing Address - Phone:714-968-3325
Mailing Address - Fax:
Practice Address - Street 1:9092 TALBERT AVE #10
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4452
Practice Address - Country:US
Practice Address - Phone:714-968-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-2948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC-2948OtherCONSUMER AFFAIRS