MEDICARE: JESSIDA PUTKAEW

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

General Provider Information

NPI Number	:	1871250837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIDA PUTKAEW

Provider Business Mailing Address
First Line	:	405 KAINS AVE STE 205
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1270
Country	:	US
Telephone Number	:	510-545-6895
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 KAINS AVE STE 205
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1270
Country	:	US
Telephone Number	:	510-545-6895
Fax Number	:

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

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	05/05/2026

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Directions to “ JESSIDA PUTKAEW ” Practice Location

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