Provider Demographics
NPI:1497853824
Name:MAC, DIA (AC)
Entity Type:Individual
Prefix:
First Name:DIA
Middle Name:
Last Name:MAC
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3005 SILVER CREEK #142
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121
Mailing Address - Country:US
Mailing Address - Phone:408-227-9088
Mailing Address - Fax:408-227-9102
Practice Address - Street 1:3005 SILVER CREEK RD #142
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-0005
Practice Address - Country:US
Practice Address - Phone:408-227-9088
Practice Address - Fax:408-227-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3406171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist