Healthcare Provider Details

I. General information

NPI: 1386189033
Provider Name (Legal Business Name): JIAN YI YE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 N MAIN ST STE 305
SANTA ANA CA
92705-6693
US

IV. Provider business mailing address

PO BOX 16054
IRVINE CA
92623-6054
US

V. Phone/Fax

Practice location:
  • Phone: 949-357-2556
  • Fax:
Mailing address:
  • Phone: 925-308-6118
  • Fax: 888-385-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17275
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: