Individual
BEN TA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
2642 VEGAS AVE, CASTRO VALLEY, CA 94546-6418
(925) 216-4838
Mailing address
2642 VEGAS AVE, CASTRO VALLEY, CA 94546-6418
(925) 216-4838
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
19550
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19550
CALIFORNIA BOARD OF ACUPUNCTURE
CA
Enumeration date
12/05/2022
Last updated
12/05/2022
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