Healthcare Provider Details

I. General information

NPI: 1063335388
Provider Name (Legal Business Name): MICHELLE YANG LAC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 W CERMAK RD
CHICAGO IL
60616-1913
US

IV. Provider business mailing address

1624 S FAIRFIELD AVE
CHICAGO IL
60608-1792
US

V. Phone/Fax

Practice location:
  • Phone: 312-847-1893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198011983
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: