Healthcare Provider Details

I. General information

NPI: 1437992658
Provider Name (Legal Business Name): JONATHAN YAM L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 FRANKLIN CORNER RD
LAWRENCE TOWNSHIP NJ
08648-2586
US

IV. Provider business mailing address

69 ONEILL CT
LAWRENCEVILLE NJ
08648-2652
US

V. Phone/Fax

Practice location:
  • Phone: 609-912-0440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00171400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: