Provider Demographics
NPI:1487716239
Name:SU, AIFENG (ACUPUNCTURIST)
Entity type:Individual
Prefix:DR
First Name:AIFENG
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 YERBA BUENA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2209
Mailing Address - Country:US
Mailing Address - Phone:408-828-2077
Mailing Address - Fax:650-559-5691
Practice Address - Street 1:11 YERBA BUENA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-2209
Practice Address - Country:US
Practice Address - Phone:408-828-2077
Practice Address - Fax:650-559-5691
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5389171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist