Healthcare Provider Details

I. General information

NPI: 1972424224
Provider Name (Legal Business Name): YAN YAN SUN LMT (LICENSED MASSAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 EAST COLOSSAL CAVE ROAD SUITE 140
VAIL AZ
85644-8757
US

IV. Provider business mailing address

14281 E. PLACITA LAGO VERDE
VAIL AZ
85641-0180
US

V. Phone/Fax

Practice location:
  • Phone: 928-812-2152
  • Fax: 520-398-7609
Mailing address:
  • Phone: 982-812-2152
  • Fax: 520-398-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-23744
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: