Healthcare Provider Details

I. General information

NPI: 1407359904
Provider Name (Legal Business Name): LISA YEUNG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 EL CAMINO REAL STE 210
LOS ALTOS CA
94022-1531
US

IV. Provider business mailing address

5050 EL CAMINO REAL STE 210
LOS ALTOS CA
94022-1531
US

V. Phone/Fax

Practice location:
  • Phone: 650-559-0011
  • Fax: 650-559-0012
Mailing address:
  • Phone: 650-559-0011
  • Fax: 650-559-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number292367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: