Healthcare Provider Details

I. General information

NPI: 1356931851
Provider Name (Legal Business Name): HOA THI CAO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 LINCOLN AVE STE 113
SAN JOSE CA
95125-3030
US

IV. Provider business mailing address

1261 LINCOLN AVE STE 113
SAN JOSE CA
95125-3030
US

V. Phone/Fax

Practice location:
  • Phone: 408-439-8969
  • Fax:
Mailing address:
  • Phone: 408-439-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number36009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: