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General NPI Number Information
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NPI Number | 1902170970
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Entity Type | Organization
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Legal Business Name | MIAN YAN
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 206 S 13TH ST
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-2313
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Country | US
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Telephone | 541-357-7530
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Fax |
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Provider Business Mailing Address
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Address Line | 206 S 13TH ST
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-2313
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Country | US
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Telephone | 541-357-7530
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | DR. DARBY VALLEY
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Credential | DAOM, L.AC.
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Telephone | 541-357-7530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC140938
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License Number State | OR
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