Healthcare Provider Details

I. General information

NPI: 1841134459
Provider Name (Legal Business Name): YUAN TIAN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 CROW CANYON RD STE 100
SAN RAMON CA
94583-1768
US

IV. Provider business mailing address

3019 CANYON VILLAGE CIR
SAN RAMON CA
94583-1876
US

V. Phone/Fax

Practice location:
  • Phone: 925-406-2461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: