Healthcare Provider Details

I. General information

NPI: 1710186895
Provider Name (Legal Business Name): MR. SIMIN YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 S ARROYO PKWY SUTE 117
PASADENA CA
91105-3255
US

IV. Provider business mailing address

703 E CALIFORNIA BLVD # 5
PASADENA CA
91106-3834
US

V. Phone/Fax

Practice location:
  • Phone: 626-487-6014
  • Fax: 626-395-7766
Mailing address:
  • Phone: 626-487-6014
  • Fax: 626-395-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: