Healthcare Provider Details

I. General information

NPI: 1699162545
Provider Name (Legal Business Name): LI HSUEH HUANG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 LAWRENCE EXPY
SUNNYVALE CA
94085
US

IV. Provider business mailing address

1080 LESLIE DR
SAN JOSE CA
95117
US

V. Phone/Fax

Practice location:
  • Phone: 408-733-1878
  • Fax:
Mailing address:
  • Phone: 140-831-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: