Healthcare Provider Details

I. General information

NPI: 1295063006
Provider Name (Legal Business Name): JENNIFER JING YAU L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875A FULMAR AVE
EWA BEACH HI
96706-3238
US

IV. Provider business mailing address

5875A FULMAR AVE
EWA BEACH HI
96706-3238
US

V. Phone/Fax

Practice location:
  • Phone: 808-492-6697
  • Fax: 808-492-6697
Mailing address:
  • Phone: 415-585-1990
  • Fax: 415-585-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number000052
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1384
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: