MEDICARE: MRS. FAYE HESTER LUONG 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	AC9647	CA

General Provider Information

NPI Number	:	1255457362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FAYE HESTER LUONG L.AC.

Provider Business Mailing Address
First Line	:	2655 CARLO SCIMECA DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2609
Country	:	US
Telephone Number	:	408-712-0201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3097 MOORPARK AVE STE 100
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2543
Country	:	US
Telephone Number	:	408-260-2458
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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