MEDICARE: CAPSOPRO SERVICES LLC

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	261Q00000X	Clinic/Center
2	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1871153957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPSOPRO SERVICES LLC

Provider Business Mailing Address
First Line	:	1825 DE LA CRUZ BLVD STE 201
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-3012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 DE LA CRUZ BLVD RM 1
Second Line	:	STE 201
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-3012
Country	:	US
Telephone Number	:	408-370-4796
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KANG-HUAI WANG
Credential	:
Telephone Number	:	408-370-4791

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	09/17/2019

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