Provider Demographics
NPI:1225451271
Name:FANG, CHIAO-JU (PHD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:CHIAO-JU
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 N SAN ANTONIO RD STE O
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1341
Mailing Address - Country:US
Mailing Address - Phone:650-434-2563
Mailing Address - Fax:
Practice Address - Street 1:885 N SAN ANTONIO RD STE O
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1341
Practice Address - Country:US
Practice Address - Phone:917-517-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18747225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist