Healthcare Provider Details

I. General information

NPI: 1427135896
Provider Name (Legal Business Name): JIMMY YUAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 N. 44TH STREET SUITE 187
PHOENIX AZ
85018-6675
US

IV. Provider business mailing address

1070 WEST SEAGULL DRIVE
CHANDLER AZ
85286-1705
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-3430
  • Fax: 480-324-0589
Mailing address:
  • Phone: 602-319-2232
  • Fax: 480-452-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7207
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: