Provider Demographics
NPI:1982947206
Name:MO, NANCY DEQIONG
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DEQIONG
Last Name:MO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N NICHOLSON AVE APT D
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-1835
Mailing Address - Country:US
Mailing Address - Phone:626-731-8806
Mailing Address - Fax:
Practice Address - Street 1:10050 GARVEY AVE STE 103
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2089
Practice Address - Country:US
Practice Address - Phone:626-731-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7125171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 7125OtherACUPUNCTURE BOARD