Healthcare Provider Details

I. General information

NPI: 1962399444
Provider Name (Legal Business Name): ENYU MA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21040 HOMESTEAD RD STE 102
CUPERTINO CA
95014-0238
US

IV. Provider business mailing address

21040 HOMESTEAD RD STE 102
CUPERTINO CA
95014-0238
US

V. Phone/Fax

Practice location:
  • Phone: 415-650-9978
  • Fax:
Mailing address:
  • Phone: 415-650-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ENYU MA
Title or Position: ACUPUNCTURIST
Credential:
Phone: 415-650-9978