Provider Demographics
NPI:1659453181
Name:KAO, HEIDI LAI (DAOM, LAC, MSTOM)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LAI
Last Name:KAO
Suffix:
Gender:F
Credentials:DAOM, LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 40TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2691
Mailing Address - Country:US
Mailing Address - Phone:510-844-0095
Mailing Address - Fax:510-844-0245
Practice Address - Street 1:430 40TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2691
Practice Address - Country:US
Practice Address - Phone:510-844-0095
Practice Address - Fax:510-844-0245
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8769171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA272051827OtherEIN