Healthcare Provider Details

I. General information

NPI: 1205103470
Provider Name (Legal Business Name): YULIYA O SMALIY LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 01/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13760 VICTORY BLVD
VAN NUYS CA
91401-2324
US

IV. Provider business mailing address

1729 ELLINCOURT DR APT 11
SOUTH PASADENA CA
91030-2176
US

V. Phone/Fax

Practice location:
  • Phone: 818-922-7713
  • Fax: 818-922-7785
Mailing address:
  • Phone: 626-799-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: