Healthcare Provider Details

I. General information

NPI: 1619792280
Provider Name (Legal Business Name): ELEMENTS HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N RENGSTORFF AVE STE A4
MOUNTAIN VIEW CA
94043-1761
US

IV. Provider business mailing address

1040 N RENGSTORFF AVE STE A4
MOUNTAIN VIEW CA
94043-1761
US

V. Phone/Fax

Practice location:
  • Phone: 510-822-1218
  • Fax:
Mailing address:
  • Phone: 510-822-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAO GU
Title or Position: OWNER
Credential:
Phone: 510-822-1218