Healthcare Provider Details

I. General information

NPI: 1437364734
Provider Name (Legal Business Name): NCACLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 CASTRO ST SUITE B
MT VIEW CA
94041
US

IV. Provider business mailing address

POB 118
MT VIEW CA
94042
US

V. Phone/Fax

Practice location:
  • Phone: 650-204-4126
  • Fax:
Mailing address:
  • Phone: 650-204-4126
  • Fax: 650-204-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11915
License Number StateCA

VIII. Authorized Official

Name: CHUNGCHAO HUANG
Title or Position: DIRECTOR
Credential:
Phone: 650-204-4126