Provider Demographics
NPI:1235639527
Name:SILICON VALLEY ACUPUNCTURE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SILICON VALLEY ACUPUNCTURE PROFESSIONAL CORPORATION
Other - Org Name:SILICON VALLEY ACUPUNCTURE PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-918-2539
Mailing Address - Street 1:881 FREMONT AVE STE A5
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5637
Mailing Address - Country:US
Mailing Address - Phone:650-918-2539
Mailing Address - Fax:
Practice Address - Street 1:881 FREMONT AVE STE A5
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5637
Practice Address - Country:US
Practice Address - Phone:650-918-2539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15237171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760806608OtherACUPUNCTURE