Provider Demographics
NPI:1982858635
Name:KATHERINE M FEDERLE DC ACPC
Entity type:Organization
Organization Name:KATHERINE M FEDERLE DC ACPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YEE PING
Authorized Official - Middle Name:WU
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-323-6294
Mailing Address - Street 1:630 OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4318
Mailing Address - Country:US
Mailing Address - Phone:650-323-6294
Mailing Address - Fax:650-324-9898
Practice Address - Street 1:630 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4318
Practice Address - Country:US
Practice Address - Phone:650-323-6294
Practice Address - Fax:650-324-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15196302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization