Healthcare Provider Details

I. General information

NPI: 1104054733
Provider Name (Legal Business Name): YAJUAN YAO LAC; LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9285 DOWDY DR SUITE 103
SAN DIEGO CA
92126-6379
US

IV. Provider business mailing address

12116 WILSEY WAY
POWAY CA
92064-2824
US

V. Phone/Fax

Practice location:
  • Phone: 858-842-8817
  • Fax:
Mailing address:
  • Phone: 858-842-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11525
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60086307
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: