Healthcare Provider Details

I. General information

NPI: 1154484475
Provider Name (Legal Business Name): DENISE DEFANG HSU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S KNICKERBOCKER DR STE 11
SUNNYVALE CA
94087-1059
US

IV. Provider business mailing address

3027 KAISER DR UNIT B
SANTA CLARA CA
95051-4745
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-9468
  • Fax: 408-736-5738
Mailing address:
  • Phone: 408-554-8620
  • Fax: 408-736-5738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC. 2888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: