Provider Demographics
NPI:1306520622
Name:KU, YU CHIN GRACE (CMT, AHC)
Entity type:Individual
Prefix:
First Name:YU CHIN
Middle Name:GRACE
Last Name:KU
Suffix:
Gender:F
Credentials:CMT, AHC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:KU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT, AHC
Mailing Address - Street 1:1695 RIVER STREET, SANTA CRUZ
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 SOQUEL AVE STE 350
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2320
Practice Address - Country:US
Practice Address - Phone:650-269-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist