Individual
FANNIE TAN KOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LIC.AC., DIPL.OM
Contact information
Practice address
259 ELM ST, SUITE 300B, SOMERVILLE, MA 02144-2950
(617) 294-9109
Mailing address
259 ELM ST, SUITE 300B, SOMERVILLE, MA 02144-2950
(617) 294-9109
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
205
NH
171100000X
Acupuncturist
Primary
253925
MA
Other
Enumeration date
05/31/2012
Last updated
02/15/2017
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