Fannie Tan Koa, LIC.AC., DIPL.OM

NPI #1588925077 in Somerville, Massachusetts

Provider Information

NPI Number: 1588925077
Entity Type: Individual
Name: Fannie Tan Koa, LIC.AC., DIPL.OM
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Acupuncturist
Credential: LIC.AC., DIPL.OM
Enumeration Date: May 31, 2012
Last Updated: Feb 15, 2017

Practice Location

Address: 259 ELM ST
Address 2: SUITE 300B
City: Somerville
State: Massachusetts
ZIP Code: 02144-2950
Phone: (617) 294-9109

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Acupuncturist	171100000X	Primary

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