Provider Demographics
NPI:1811379290
Name:LING, KATY (LAC)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:LING
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 1:2301 SUNSET BLVD
Mailing Address - Street 2:1309
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4372
Mailing Address - Country:US
Mailing Address - Phone:415-254-5267
Mailing Address - Fax:
Practice Address - Street 1:2301 SUNSET BLVD
Practice Address - Street 2:1309
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4372
Practice Address - Country:US
Practice Address - Phone:415-254-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist