Healthcare Provider Details

I. General information

NPI: 1083966741
Provider Name (Legal Business Name): ZHENG-JIE KUO L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 87TH ST STE C
DALY CITY CA
94015-1754
US

IV. Provider business mailing address

307 87TH ST STE C
DALY CITY CA
94015-1754
US

V. Phone/Fax

Practice location:
  • Phone: 415-636-7345
  • Fax:
Mailing address:
  • Phone: 415-636-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: