Provider Demographics
NPI:1750269411
Name:CHAN, CINDY C (LAC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:C
Last Name:CHAN
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 1:2865 HOMESTEAD RD APT 22
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5288
Mailing Address - Country:US
Mailing Address - Phone:510-356-8161
Mailing Address - Fax:
Practice Address - Street 1:2865 HOMESTEAD RD APT 22
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5288
Practice Address - Country:US
Practice Address - Phone:510-356-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20331171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist