Provider Demographics
NPI:1235618885
Name:MUONG-KEO, BORAVY (LAC)
Entity Type:Individual
Prefix:MRS
First Name:BORAVY
Middle Name:
Last Name:MUONG-KEO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:BORAVY
Other - Middle Name:
Other - Last Name:MUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3278 PADILLA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2745
Mailing Address - Country:US
Mailing Address - Phone:408-834-3396
Mailing Address - Fax:
Practice Address - Street 1:3278 PADILLA WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2745
Practice Address - Country:US
Practice Address - Phone:408-834-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17791171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist