Provider Demographics
NPI:1487724027
Name:KLAWONN, BODO (LAC)
Entity type:Individual
Prefix:
First Name:BODO
Middle Name:
Last Name:KLAWONN
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 1:544-A PRECITA AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4720
Mailing Address - Country:US
Mailing Address - Phone:415-647-6689
Mailing Address - Fax:
Practice Address - Street 1:1560 GEER RD
Practice Address - Street 2:SUITE F
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3233
Practice Address - Country:US
Practice Address - Phone:209-632-1162
Practice Address - Fax:209-632-1162
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4911171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist