Provider Demographics
NPI:1578624995
Name:SHI, CHENGGUANG (LICENSED ACUPUNCTURI)
Entity type:Individual
Prefix:
First Name:CHENGGUANG
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 E ARQUES AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5419
Mailing Address - Country:US
Mailing Address - Phone:650-917-9699
Mailing Address - Fax:650-917-9199
Practice Address - Street 1:1208 E ARQUES AVE STE 111
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5419
Practice Address - Country:US
Practice Address - Phone:650-917-9699
Practice Address - Fax:650-917-9199
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist