Provider Demographics
NPI:1104007004
Name:HUANG, KACY (LAC)
Entity Type:Individual
Prefix:MS
First Name:KACY
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 GALLERIA DR APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2440
Mailing Address - Country:US
Mailing Address - Phone:140-842-1374
Mailing Address - Fax:
Practice Address - Street 1:434 GALLERIA DR APT 11
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2440
Practice Address - Country:US
Practice Address - Phone:140-842-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12117171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist