Healthcare Provider Details

I. General information

NPI: 1073676797
Provider Name (Legal Business Name): TIECHENG HONG L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21607 STEVENS CREEK BL
CUPERTINO CA
95014
US

IV. Provider business mailing address

1236 CORTEZ DR APT 12
SUNNYVALE CA
94086-5672
US

V. Phone/Fax

Practice location:
  • Phone: 408-316-0662
  • Fax:
Mailing address:
  • Phone: 650-965-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: