Provider Demographics
NPI:1457386195
Name:RAY, TED (LAC)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:2660 SOLACE PL STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4337
Mailing Address - Country:US
Mailing Address - Phone:650-564-9002
Mailing Address - Fax:650-332-4771
Practice Address - Street 1:2500 HOSPITAL DR
Practice Address - Street 2:3B
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4106
Practice Address - Country:US
Practice Address - Phone:650-564-9002
Practice Address - Fax:650-564-9005
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC8298171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCA0082980Medicare UPIN