Provider Demographics
NPI:1659505188
Name:GU, CHAOJUAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:CHAOJUAN
Middle Name:
Last Name:GU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N MILPITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-2727
Mailing Address - Country:US
Mailing Address - Phone:408-263-3988
Mailing Address - Fax:408-263-3928
Practice Address - Street 1:1717 N MILPITAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-2727
Practice Address - Country:US
Practice Address - Phone:408-263-3988
Practice Address - Fax:408-263-3928
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13006171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist