Provider Demographics
NPI:1265806517
Name:SANDY, ZACHARY (LAC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:SANDY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 CORSAIR LN
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2681
Mailing Address - Country:US
Mailing Address - Phone:650-619-5923
Mailing Address - Fax:
Practice Address - Street 1:2001 WINWARD WAY STE 102
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-2499
Practice Address - Country:US
Practice Address - Phone:650-924-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16747171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist