Healthcare Provider Details

I. General information

NPI: 1700544608
Provider Name (Legal Business Name): YUANLONG HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 N WINCHESTER BLVD STE 2
SAN JOSE CA
95128-1150
US

IV. Provider business mailing address

1360 N WINCHESTER BLVD STE 2
SAN JOSE CA
95128-1150
US

V. Phone/Fax

Practice location:
  • Phone: 408-641-9133
  • Fax: 831-854-9391
Mailing address:
  • Phone: 408-641-9133
  • Fax: 831-854-9391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC19321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: