Provider Demographics
NPI:1568639110
Name:HU, CONG (LAC OMD)
Entity Type:Individual
Prefix:
First Name:CONG
Middle Name:
Last Name:HU
Suffix:
Gender:M
Credentials:LAC OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 W REMINGTON DR
Mailing Address - Street 2:APT 5B
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087
Mailing Address - Country:US
Mailing Address - Phone:408-481-1767
Mailing Address - Fax:408-481-1767
Practice Address - Street 1:2304 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403
Practice Address - Country:US
Practice Address - Phone:408-481-1767
Practice Address - Fax:408-481-1767
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist