Healthcare Provider Details

I. General information

NPI: 1568232825
Provider Name (Legal Business Name): ALICE YUN JU HUANG L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 VICAR LN
SAN JOSE CA
95117-2567
US

IV. Provider business mailing address

961 VICAR LN
SAN JOSE CA
95117-2567
US

V. Phone/Fax

Practice location:
  • Phone: 408-218-0555
  • Fax:
Mailing address:
  • Phone: 408-218-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: