1295892362 NPI number — MRS. SUSAN SHAO L.AC.

Table of content: MRS. SUSAN SHAO L.AC. (NPI 1295892362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295892362 NPI number — MRS. SUSAN SHAO L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAO
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAO
Provider Other First Name:
SUSAN
Provider Other Middle Name:
S.C.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295892362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9092 TALBERT AVE
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-4452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-968-3325
Provider Business Mailing Address Fax Number:
714-968-6656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9092 TALBERT AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-4452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-968-3325
Provider Business Practice Location Address Fax Number:
714-968-6656
Provider Enumeration Date:
01/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC2948 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CA0029480 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5761398 . This is a "COVENTRY HEALTH CARE/FIRST HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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