Provider Demographics
NPI:1669501359
Name:SON, KEIBUN
Entity Type:Individual
Prefix:
First Name:KEIBUN
Middle Name:
Last Name:SON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700767
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95170-0767
Mailing Address - Country:US
Mailing Address - Phone:408-253-3578
Mailing Address - Fax:408-873-0903
Practice Address - Street 1:800 CALIFORNIA ST STE 120
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-2810
Practice Address - Country:US
Practice Address - Phone:408-253-3578
Practice Address - Fax:408-873-0903
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist