Provider Demographics
NPI:1518042977
Name:CHAU, JACKSON (LAC)
Entity Type:Individual
Prefix:MR
First Name:JACKSON
Middle Name:
Last Name:CHAU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 JUDAH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1124
Mailing Address - Country:US
Mailing Address - Phone:415-566-0832
Mailing Address - Fax:415-566-0832
Practice Address - Street 1:4117 JUDAH STREE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1124
Practice Address - Country:US
Practice Address - Phone:415-566-0832
Practice Address - Fax:415-566-0832
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC5040246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAC5040OtherACUPUNCTURISTS