Provider Demographics
NPI:1306262928
Name:KANE, IRENE (DAOM, LAC)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 S BASCOM AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2674
Mailing Address - Country:US
Mailing Address - Phone:408-482-1767
Mailing Address - Fax:
Practice Address - Street 1:3880 S BASCOM AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2674
Practice Address - Country:US
Practice Address - Phone:408-482-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15271171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist