Healthcare Provider Details

I. General information

NPI: 1265875884
Provider Name (Legal Business Name): GUARDIAN ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 S DE ANZA BLVD
SAN JOSE CA
95129-4608
US

IV. Provider business mailing address

1614 S DE ANZA BLVD
SAN JOSE CA
95129-4608
US

V. Phone/Fax

Practice location:
  • Phone: 408-996-8404
  • Fax: 415-996-8004
Mailing address:
  • Phone: 408-996-8404
  • Fax: 415-996-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number6494
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6494
License Number StateCA

VIII. Authorized Official

Name: MAOJUNG YEH
Title or Position: OWNER OF GUARDIAN ACUPUNCTURE
Credential: L.AC
Phone: 408-996-8404