Healthcare Provider Details

I. General information

NPI: 1184133514
Provider Name (Legal Business Name): JING YANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LA CASA VIA STE 102
WALNUT CREEK CA
94598-3000
US

IV. Provider business mailing address

1253 POPPY SEED CT
CONCORD CA
94520-4460
US

V. Phone/Fax

Practice location:
  • Phone: 925-938-3908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: