Provider Demographics
NPI:1700916145
Name:MIYASHITA, KOICHI (LAC)
Entity Type:Individual
Prefix:MR
First Name:KOICHI
Middle Name:
Last Name:MIYASHITA
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 1:1010 DOYLE STREET
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4315
Mailing Address - Country:US
Mailing Address - Phone:650-322-8818
Mailing Address - Fax:650-322-8818
Practice Address - Street 1:1010 DOYLE STREET
Practice Address - Street 2:SUITE 14
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4315
Practice Address - Country:US
Practice Address - Phone:650-322-8818
Practice Address - Fax:650-322-8818
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2775171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist