Provider Demographics
NPI:1033345905
Name:SHA, YONG CHUN (LCA)
Entity Type:Individual
Prefix:MS
First Name:YONG
Middle Name:CHUN
Last Name:SHA
Suffix:
Gender:F
Credentials:LCA
Other - Prefix:MS
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:SHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCA
Mailing Address - Street 1:PO BOX 2746
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95015-2746
Mailing Address - Country:US
Mailing Address - Phone:408-585-8770
Mailing Address - Fax:408-773-8961
Practice Address - Street 1:1324 S MARY AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3130
Practice Address - Country:US
Practice Address - Phone:408-585-8770
Practice Address - Fax:408-773-8961
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12965171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist