Provider Demographics
NPI:1972775260
Name:FRED DONG ACUPUNCTURE
Entity Type:Organization
Organization Name:FRED DONG ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:408-366-1330
Mailing Address - Street 1:430 MONTEREY AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5323
Mailing Address - Country:US
Mailing Address - Phone:408-399-9888
Mailing Address - Fax:
Practice Address - Street 1:430 MONTEREY AVE STE 1B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5323
Practice Address - Country:US
Practice Address - Phone:408-399-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12102302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12102OtherACUPUNCTURE