Healthcare Provider Details

I. General information

NPI: 1225366594
Provider Name (Legal Business Name): YAN ZHU ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14805 JEFFREY RD STE G
IRVINE CA
92618-0407
US

IV. Provider business mailing address

14805 JEFFREY RD SUITE# G
IRVINE CA
92618-0406
US

V. Phone/Fax

Practice location:
  • Phone: 949-786-9284
  • Fax:
Mailing address:
  • Phone: 949-786-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: