Provider Demographics
NPI:1689820110
Name:LAU, JAVIS SIU LAN (DAOM)
Entity Type:Individual
Prefix:MISS
First Name:JAVIS
Middle Name:SIU LAN
Last Name:LAU
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 WALSH AVE
Mailing Address - Street 2:#133
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2500
Mailing Address - Country:US
Mailing Address - Phone:408-507-4281
Mailing Address - Fax:
Practice Address - Street 1:6116 CAMINO VERDE DR
Practice Address - Street 2:#10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1441
Practice Address - Country:US
Practice Address - Phone:408-865-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12311171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist