Provider Demographics
NPI:1871285080
Name:CHAO, YI-CHUNG (PHD, LAC)
Entity type:Individual
Prefix:
First Name:YI-CHUNG
Middle Name:
Last Name:CHAO
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325B MOORPARK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2029
Mailing Address - Country:US
Mailing Address - Phone:408-390-8377
Mailing Address - Fax:
Practice Address - Street 1:4325 MOORPARK AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2076
Practice Address - Country:US
Practice Address - Phone:408-390-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17736171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist