Provider Demographics
NPI:1366592016
Name:LEGASSIC, KELLY FRANCIS LOUIS (LAC)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:FRANCIS LOUIS
Last Name:LEGASSIC
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 SHOTWELL STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4015
Mailing Address - Country:US
Mailing Address - Phone:415-309-4965
Mailing Address - Fax:
Practice Address - Street 1:1055 SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4015
Practice Address - Country:US
Practice Address - Phone:415-309-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9063171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist