=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962738617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNETH HU
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2009
-----------------------------------------------------
Last Update Date | 03/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3571 HOMESTEAD RD
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95051-5161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-899-6087
-----------------------------------------------------
Fax | 408-982-5672
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3571 HOMESTEAD RD
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95051-5161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-899-6087
-----------------------------------------------------
Fax | 408-982-5672
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. KENNETH HU
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 626-652-5678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 12586
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------