Healthcare Provider Details

I. General information

NPI: 1104034263
Provider Name (Legal Business Name): ALAN YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARIN ST STE 109
THOUSAND OAKS CA
91360
US

IV. Provider business mailing address

608 E VALLEY BLVD # D119
SAN GABRIEL CA
91776-3594
US

V. Phone/Fax

Practice location:
  • Phone: 626-675-6299
  • Fax:
Mailing address:
  • Phone: 626-675-6299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: