Provider Demographics
NPI:1326394883
Name:TERESA T SHEN, PH.D, L.AC, INC, A PROFESSIONAL ACUPUNCTURE CORPORATION
Entity type:Organization
Organization Name:TERESA T SHEN, PH.D, L.AC, INC, A PROFESSIONAL ACUPUNCTURE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LAC
Authorized Official - Phone:925-847-8889
Mailing Address - Street 1:3510 OLD SANTA RITA RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3466
Mailing Address - Country:US
Mailing Address - Phone:925-847-8889
Mailing Address - Fax:925-847-4180
Practice Address - Street 1:3510 OLD SANTA RITA RD
Practice Address - Street 2:SUITE D
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3466
Practice Address - Country:US
Practice Address - Phone:925-847-8889
Practice Address - Fax:925-847-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty