Provider Demographics
NPI:1225514342
Name:KING, DEBORAH FANDI
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:FANDI
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FANDI
Other - Middle Name:
Other - Last Name:JIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1590 OAKLAND RD STE B103
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2444
Mailing Address - Country:US
Mailing Address - Phone:530-780-5600
Mailing Address - Fax:
Practice Address - Street 1:1590 OAKLAND RD STE B103
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2444
Practice Address - Country:US
Practice Address - Phone:530-780-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18142171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18142OtherACUPUNCTURE