Healthcare Provider Details

I. General information

NPI: 1851446173
Provider Name (Legal Business Name): JING-ING KUO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 ENCINAL AVE STE H
ALAMEDA CA
94501-4881
US

IV. Provider business mailing address

3215 ENCINAL AVE STE H
ALAMEDA CA
94501-4881
US

V. Phone/Fax

Practice location:
  • Phone: 650-255-5283
  • Fax:
Mailing address:
  • Phone: 650-255-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: