MEDICARE: LI YUAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	225700000X	WA

General Provider Information

NPI Number	:	1467069328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LI YUAN

Provider Business Mailing Address
First Line	:	4612 NE 39TH ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98661-3500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11516 SE MILL PLAIN BLVD
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98684-5005
Country	:	US
Telephone Number	:	360-253-6674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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Directions to “ LI YUAN ” Practice Location

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