Provider Demographics
NPI:1760001341
Name:INOUYE, AUDREY CARYL (LAC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:CARYL
Last Name:INOUYE
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 1:1164 POWELL ST APT 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2617
Mailing Address - Country:US
Mailing Address - Phone:925-324-3467
Mailing Address - Fax:
Practice Address - Street 1:4052 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2534
Practice Address - Country:US
Practice Address - Phone:925-324-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist