Healthcare Provider Details

I. General information

NPI: 1275489072
Provider Name (Legal Business Name): YU-TAO YI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 E VALLEY BLVD STE 101
WEST COVINA CA
91792-3196
US

IV. Provider business mailing address

2707 E VALLEY BLVD STE 101
WEST COVINA CA
91792-3196
US

V. Phone/Fax

Practice location:
  • Phone: 626-964-6588
  • Fax:
Mailing address:
  • Phone: 626-964-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: