=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497266225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YITING CHUANG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2017
-----------------------------------------------------
Last Update Date | 09/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1765 SCOTT BLVD STE 101
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95050-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-758-8925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1765 SCOTT BLVD STE 101
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95050-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-758-8925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC17805
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------