Healthcare Provider Details

I. General information

NPI: 1639934482
Provider Name (Legal Business Name): YUKI TAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39210 STATE ST STE 220
FREMONT CA
94538-1456
US

IV. Provider business mailing address

580 TELFORD CT
HAYWARD CA
94544-6693
US

V. Phone/Fax

Practice location:
  • Phone: 408-772-3775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT24390717
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: