Provider Demographics
NPI:1902133051
Name:YOUSSEF, DANA (LAC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 LEIGH AVE
Mailing Address - Street 2:#7
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4528
Mailing Address - Country:US
Mailing Address - Phone:408-297-4248
Mailing Address - Fax:
Practice Address - Street 1:1609 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5532
Practice Address - Country:US
Practice Address - Phone:408-448-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8575171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist