Provider Demographics
NPI:1982000691
Name:HAYNES, ISAAC SAMUEL (PHD, MATCM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:SAMUEL
Last Name:HAYNES
Suffix:
Gender:M
Credentials:PHD, MATCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 TASMAN DR
Mailing Address - Street 2:APT. 3213
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-4746
Mailing Address - Country:US
Mailing Address - Phone:650-785-6888
Mailing Address - Fax:888-391-8562
Practice Address - Street 1:10580 S DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4450
Practice Address - Country:US
Practice Address - Phone:650-785-6888
Practice Address - Fax:888-391-8562
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16760171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist