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General NPI Number Information
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NPI Number | 1922529197
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Entity Type | Individual
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Provider Name | SIRIPORN USANAKORNKUL L.AC.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 800 POLLARD RD STE B203
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City | LOS GATOS
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State | CA
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Zip | 95032-1429
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Country | US
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Telephone | 415-307-7560
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Fax |
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Provider Business Mailing Address
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Address Line | 3968 WILDFLOWER CMN
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City | FREMONT
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State | CA
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Zip | 94538-5571
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Country | US
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Telephone | 415-307-7560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 13335
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License Number State | CA
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