Healthcare Provider Details

I. General information

NPI: 1225371800
Provider Name (Legal Business Name): ANDY HUANG L.AC., DAOM, OM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 PERALTA CT
CUPERTINO CA
95014-6568
US

IV. Provider business mailing address

10502 PERALTA CT
CUPERTINO CA
95014-6568
US

V. Phone/Fax

Practice location:
  • Phone: 408-489-8989
  • Fax:
Mailing address:
  • Phone: 650-210-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number154560
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: