Provider Demographics
NPI:1902230709
Name:VAN DER HOOG, MASJA (MSOM, LAC, LAMT)
Entity Type:Individual
Prefix:MISS
First Name:MASJA
Middle Name:
Last Name:VAN DER HOOG
Suffix:
Gender:F
Credentials:MSOM, LAC, LAMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 23RD AVE
Mailing Address - Street 2:APT 10
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606
Mailing Address - Country:US
Mailing Address - Phone:510-927-6800
Mailing Address - Fax:
Practice Address - Street 1:1511 23RD AVE
Practice Address - Street 2:APT 10
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606
Practice Address - Country:US
Practice Address - Phone:510-927-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13870171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist