Provider Demographics
NPI:1528354297
Name:FEY, SEBASTIAN (LAC)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:
Last Name:FEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BRANNAN ST APT 212
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2075
Mailing Address - Country:US
Mailing Address - Phone:415-800-3886
Mailing Address - Fax:
Practice Address - Street 1:2001 VAN NESS AVE STE 404
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3024
Practice Address - Country:US
Practice Address - Phone:415-800-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14282171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist