Healthcare Provider Details

I. General information

NPI: 1073704045
Provider Name (Legal Business Name): SUSAN S.Q. AU-YANG D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 LOVELL AVE
MILL VALLEY CA
94941-1053
US

IV. Provider business mailing address

PO BOX 1813
MILL VALLEY CA
94942-1813
US

V. Phone/Fax

Practice location:
  • Phone: 415-898-2266
  • Fax:
Mailing address:
  • Phone: 415-383-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number162470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: