Healthcare Provider Details

I. General information

NPI: 1053021345
Provider Name (Legal Business Name): YVONNE YEN KIM HUA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 INLAND EMPIRE BLVD STE B120
ONTARIO CA
91764-4997
US

IV. Provider business mailing address

1885 CHARNWOOD CT
SAN JOSE CA
95132-1713
US

V. Phone/Fax

Practice location:
  • Phone: 909-265-9500
  • Fax:
Mailing address:
  • Phone: 408-315-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: