Healthcare Provider Details

I. General information

NPI: 1720702848
Provider Name (Legal Business Name): YANYAN HUANG L. AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2254 N 1ST ST
SAN JOSE CA
95131-2022
US

IV. Provider business mailing address

1329 PARK ENTRANCE DR
SAN JOSE CA
95131-3017
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-1288
  • Fax:
Mailing address:
  • Phone: 805-807-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: