Provider Demographics
NPI:1902150808
Name:TAN, SHENGYAN GRACE (LAC)
Entity type:Individual
Prefix:
First Name:SHENGYAN
Middle Name:GRACE
Last Name:TAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2700 W ANDERSON LN STE 512
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1359
Mailing Address - Country:US
Mailing Address - Phone:512-467-0370
Mailing Address - Fax:512-454-8846
Practice Address - Street 1:2700 W ANDERSON LN STE 512
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1359
Practice Address - Country:US
Practice Address - Phone:512-467-0370
Practice Address - Fax:512-454-8846
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist