Provider Demographics
NPI:1336442078
Name:MICHAEL NIAN PENG SHI, L.AC., PH.D.
Entity Type:Organization
Organization Name:MICHAEL NIAN PENG SHI, L.AC., PH.D.
Other - Org Name:NIAN PENG SHI, L.AC.,PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIAN PENG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHI
Authorized Official - Suffix:
Authorized Official - Credentials:MSTCM, PHD
Authorized Official - Phone:510-704-8888
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4182261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty