Healthcare Provider Details

I. General information

NPI: 1548076110
Provider Name (Legal Business Name): YU YANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4193 FLAT ROCK DR STE 200
RIVERSIDE CA
92505-7113
US

IV. Provider business mailing address

4193 FLAT ROCK DR STE 200
RIVERSIDE CA
92505-7113
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-5330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: YU YANG
Title or Position: ACUPUNCTURIST
Credential:
Phone: 626-662-5365