Provider Demographics
NPI:1881018562
Name:COOPER, KIRSTEN (LAC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:COOPER
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 1:1119 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3823
Mailing Address - Country:US
Mailing Address - Phone:650-387-5652
Mailing Address - Fax:
Practice Address - Street 1:626 JEFFERSON AVE STE 3
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1726
Practice Address - Country:US
Practice Address - Phone:650-503-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist