Healthcare Provider Details

I. General information

NPI: 1740481688
Provider Name (Legal Business Name): CHAI YI HONG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHESTER HONG PHD

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BROADWAY
MILLBRAE CA
94030-2508
US

IV. Provider business mailing address

290 BROADWAY
MILLBRAE CA
94030-2508
US

V. Phone/Fax

Practice location:
  • Phone: 650-692-6828
  • Fax:
Mailing address:
  • Phone: 650-692-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: