=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104393818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIYUN YE ACUPUNCTURE CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2018
-----------------------------------------------------
Last Update Date | 10/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2742 CONCORD BLVD
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94519-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-609-8822
-----------------------------------------------------
Fax | 925-363-0099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2742 CONCORD BLVD
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94519-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-609-8822
-----------------------------------------------------
Fax | 925-363-0099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LIYUN YE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-609-8822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------