Provider Demographics
NPI:1144361270
Name:LUM, STEPHANIE ANN (LAC,RCP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:LUM
Suffix:
Gender:F
Credentials:LAC,RCP
Other - Prefix:
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Mailing Address - Street 1:28 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3303
Mailing Address - Country:US
Mailing Address - Phone:415-892-3402
Mailing Address - Fax:415-459-8938
Practice Address - Street 1:907 IRWIN ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3317
Practice Address - Country:US
Practice Address - Phone:415-459-2245
Practice Address - Fax:415-459-8938
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACJ2590171100000X
CA8754227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified