Healthcare Provider Details

I. General information

NPI: 1831254069
Provider Name (Legal Business Name): YAN CAO LICAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 INDEPENDENCE DR
CHESTNUT HILL MA
02467-3628
US

IV. Provider business mailing address

51 CLOVERDALE RD
NEWTON MA
02461-1810
US

V. Phone/Fax

Practice location:
  • Phone: 617-541-6350
  • Fax:
Mailing address:
  • Phone: 617-549-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number521
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: