Provider Demographics
NPI:1205880515
Name:KO, ELIZABETH YUAN-MAE (L AC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:YUAN-MAE
Last Name:KO
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 MERIDIAN AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2700
Mailing Address - Country:US
Mailing Address - Phone:408-227-4960
Mailing Address - Fax:
Practice Address - Street 1:6055 MERIDIAN AVE STE 30
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2700
Practice Address - Country:US
Practice Address - Phone:408-227-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8664171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist