Healthcare Provider Details

I. General information

NPI: 1851075121
Provider Name (Legal Business Name): YANSONG SHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 E SOUTH ST STE 108
LONG BEACH CA
90805-4461
US

IV. Provider business mailing address

1624 S MARGUERITA AVE
ALHAMBRA CA
91803-3147
US

V. Phone/Fax

Practice location:
  • Phone: 562-470-6350
  • Fax:
Mailing address:
  • Phone: 626-537-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC19770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: