Healthcare Provider Details

I. General information

NPI: 1225109788
Provider Name (Legal Business Name): CHUN CAO L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074A SCOTT BLVD
SANTA CLARA CA
95054-3325
US

IV. Provider business mailing address

3074A SCOTT BLVD
SANTA CLARA CA
95054-3325
US

V. Phone/Fax

Practice location:
  • Phone: 408-988-6988
  • Fax: 408-988-3988
Mailing address:
  • Phone: 408-988-6988
  • Fax: 408-988-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberL.AC 7439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: