Provider Demographics
NPI:1851977623
Name:WOO, JERRY (LAC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:WOO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 W HEDDING ST
Mailing Address - Street 2:STE 212
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1428
Mailing Address - Country:US
Mailing Address - Phone:408-800-2106
Mailing Address - Fax:510-902-1559
Practice Address - Street 1:2007 W HEDDING ST
Practice Address - Street 2:STE 212
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1428
Practice Address - Country:US
Practice Address - Phone:408-800-2106
Practice Address - Fax:510-902-1559
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19066171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist