Provider Demographics
NPI:1578624995
Name:SHI, CHENGGUANG (LICENSED ACUPUNCTURI)
Entity Type:Individual
Prefix:
First Name:CHENGGUANG
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10066 S TANTAU AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3542
Mailing Address - Country:US
Mailing Address - Phone:408-517-0378
Mailing Address - Fax:
Practice Address - Street 1:10066 S TANTAU AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3542
Practice Address - Country:US
Practice Address - Phone:408-517-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist