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General NPI Number Information
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NPI Number | 1700609708
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Entity Type | Organization
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Legal Business Name | LE YUAN AESTHETIC LLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 711 CANTON RD NE STE 400
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City | MARIETTA
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State | GA
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Zip | 30060-8949
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Country | US
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Telephone | 248-202-5931
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Fax |
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Provider Business Mailing Address
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Address Line | 140 BELMONT TRCE
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-3066
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Country | US
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Telephone | 248-202-5931
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANK YUAN
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Credential |
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Telephone | 248-202-5931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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