Healthcare Provider Details

I. General information

NPI: 1811337249
Provider Name (Legal Business Name): LAO LAO ACUPUNCTURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2013
Last Update Date: 06/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 TECHNOLOGY DR SUITE 128
SAN JOSE CA
95110-1308
US

IV. Provider business mailing address

1754 TECHNOLOGY DR SUITE 128
SAN JOSE CA
95110-1308
US

V. Phone/Fax

Practice location:
  • Phone: 510-557-2380
  • Fax:
Mailing address:
  • Phone: 510-557-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15173
License Number StateCA

VIII. Authorized Official

Name: JINGHUA XU
Title or Position: CEO
Credential:
Phone: 510-557-2380