Provider Demographics
NPI:1538540422
Name:CHAU, JOSEPHINE (LAC)
Entity type:Individual
Prefix:MISS
First Name:JOSEPHINE
Middle Name:
Last Name:CHAU
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 1:17923 TANGERINE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-7079
Mailing Address - Country:US
Mailing Address - Phone:951-801-4217
Mailing Address - Fax:
Practice Address - Street 1:6841 MAGNOLIA AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2864
Practice Address - Country:US
Practice Address - Phone:951-801-4217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10001171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist