Provider Demographics
NPI:1801268289
Name:HODGE, I-PEI HSIU (LAC)
Entity type:Individual
Prefix:
First Name:I-PEI
Middle Name:HSIU
Last Name:HODGE
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 1:3532 BROOKDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2010
Mailing Address - Country:US
Mailing Address - Phone:510-508-0247
Mailing Address - Fax:
Practice Address - Street 1:917 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 295
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4005
Practice Address - Country:US
Practice Address - Phone:510-508-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16907171100000X
TXAC01612171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist