Healthcare Provider Details

I. General information

NPI: 1679766828
Provider Name (Legal Business Name): YUNFAN YANG ND, LAC, LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 228TH ST SE
BOTHELL WA
98021-9316
US

IV. Provider business mailing address

825 228TH ST SE
BOTHELL WA
98021-9317
US

V. Phone/Fax

Practice location:
  • Phone: 425-806-4861
  • Fax: 425-806-4861
Mailing address:
  • Phone: 425-806-4861
  • Fax: 425-806-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT 60524196
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00023117
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 60740047
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: