Provider Demographics
NPI:1053804211
Name:HA, INYOUNG (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:INYOUNG
Middle Name:
Last Name:HA
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:MS
Other - First Name:INYOUNG
Other - Middle Name:HA
Other - Last Name:VENEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:1240 SAN TOMAS AQUINO RD APT 106A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3373
Mailing Address - Country:US
Mailing Address - Phone:925-255-3888
Mailing Address - Fax:
Practice Address - Street 1:1240 SAN TOMAS AQUINO RD APT 106A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-3373
Practice Address - Country:US
Practice Address - Phone:925-255-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist