Healthcare Provider Details

I. General information

NPI: 1497564595
Provider Name (Legal Business Name): YAN DENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 W BADILLO ST
COVINA CA
91723-1906
US

IV. Provider business mailing address

3381 SUMMERS CT
RIVERSIDE CA
92501-1491
US

V. Phone/Fax

Practice location:
  • Phone: 626-743-2498
  • Fax:
Mailing address:
  • Phone: 626-274-2518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: