Healthcare Provider Details

I. General information

NPI: 1982000691
Provider Name (Legal Business Name): ISAAC SAMUEL HAYNES PHD, MATCM, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10580 S DE ANZA BLVD
CUPERTINO CA
95014-4450
US

IV. Provider business mailing address

695 TASMAN DR APT. 3213
SUNNYVALE CA
94089-4746
US

V. Phone/Fax

Practice location:
  • Phone: 650-785-6888
  • Fax: 888-391-8562
Mailing address:
  • Phone: 650-785-6888
  • Fax: 888-391-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: