MEDICARE: MRS. ELIZABETH YUAN-MAE KO L AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC8664	CA

General Provider Information

NPI Number	:	1205880515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH YUAN-MAE KO L AC

Provider Business Mailing Address
First Line	:	6055 MERIDIAN AVE STE 30
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2700
Country	:	US
Telephone Number	:	408-227-4960
Fax Number	:

Provider Business Practice Location Address
First Line	:	6055 MERIDIAN AVE STE 30
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2700
Country	:	US
Telephone Number	:	408-227-4960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/01/2023

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