Provider Demographics
NPI:1841047164
Name:KAN, VIVIAN (DC, LAC)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S AMPHLETT BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2527
Mailing Address - Country:US
Mailing Address - Phone:650-242-5591
Mailing Address - Fax:
Practice Address - Street 1:1660 S AMPHLETT BLVD STE 308
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2527
Practice Address - Country:US
Practice Address - Phone:650-242-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34918111N00000X
CA19786171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor