Provider Demographics
NPI:1144353657
Name:LIGHT, RICHARD LEONARD
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEONARD
Last Name:LIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:LEONARD
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1807 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1107
Mailing Address - Country:US
Mailing Address - Phone:415-355-0594
Mailing Address - Fax:415-355-0594
Practice Address - Street 1:1807 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1107
Practice Address - Country:US
Practice Address - Phone:415-355-0594
Practice Address - Fax:415-355-0594
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7923171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist