Provider Demographics
NPI:1407148703
Name:HINGLE, DANIEL ANTHONY (LAC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ANTHONY
Last Name:HINGLE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:HINGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:5639 PARK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-3354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15466 LOS GATOS BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2542
Practice Address - Country:US
Practice Address - Phone:408-356-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14185171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC14185OtherCALIFORNIA ACUPUNCTURE BOARD LICENSE NO.