Provider Demographics
NPI:1003909425
Name:OH, FAITH M (LICENSEACUPUNCTURIST)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:M
Last Name:OH
Suffix:
Gender:F
Credentials:LICENSEACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 EL CAMINO REAL
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-5376
Mailing Address - Country:US
Mailing Address - Phone:650-225-0808
Mailing Address - Fax:650-225-0809
Practice Address - Street 1:1590 EL CAMINO REAL
Practice Address - Street 2:SUITE G
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-5376
Practice Address - Country:US
Practice Address - Phone:650-225-0808
Practice Address - Fax:650-225-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0034450171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0034450Medicaid