Provider Demographics
NPI:1881099562
Name:PAE, SANG
Entity type:Individual
Prefix:
First Name:SANG
Middle Name:
Last Name:PAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2263
Mailing Address - Country:US
Mailing Address - Phone:408-677-8191
Mailing Address - Fax:
Practice Address - Street 1:998 E EL CAMINO REAL
Practice Address - Street 2:SUITE 202
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-7926
Practice Address - Country:US
Practice Address - Phone:408-688-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15276171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist