Provider Demographics
NPI:1780277590
Name:AN, PEIDE (MD)
Entity type:Individual
Prefix:
First Name:PEIDE
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:450 FOLSOM ST APT 1406
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3369
Mailing Address - Country:US
Mailing Address - Phone:510-894-5345
Mailing Address - Fax:
Practice Address - Street 1:450 FOLSOM ST APT 1406
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3369
Practice Address - Country:US
Practice Address - Phone:510-894-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist