Healthcare Provider Details

I. General information

NPI: 1265791107
Provider Name (Legal Business Name): JI SUN YANG L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2012
Last Update Date: 05/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N DEREK DR APT 227
FULLERTON CA
92831-1438
US

IV. Provider business mailing address

2001 N DEREK DR APT 227
FULLERTON CA
92831-1438
US

V. Phone/Fax

Practice location:
  • Phone: 714-345-3202
  • Fax:
Mailing address:
  • Phone: 714-345-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 14857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: