Healthcare Provider Details

I. General information

NPI: 1861550840
Provider Name (Legal Business Name): DR. TIM TINGKUO KUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 HOSTETTER RD
SAN JOSE CA
95132-2233
US

IV. Provider business mailing address

2801 HOSTETTER RD
SAN JOSE CA
95132-2233
US

V. Phone/Fax

Practice location:
  • Phone: 408-258-6028
  • Fax:
Mailing address:
  • Phone: 408-258-6028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: