Healthcare Provider Details

I. General information

NPI: 1831494251
Provider Name (Legal Business Name): CHUNG CHAO HUANG L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 OAKLAND RD SUITE #C100
SAN JOSE CA
95131-2440
US

IV. Provider business mailing address

1580 OAKLAND RD SUITE #C100
SAN JOSE CA
95131-2440
US

V. Phone/Fax

Practice location:
  • Phone: 408-657-0889
  • Fax:
Mailing address:
  • Phone: 408-657-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: