MEDICARE: PRO REHAB CLINIC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1851960454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO REHAB CLINIC INC.

Provider Business Mailing Address
First Line	:	2373 S HACIENDA BLVD
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4613
Country	:	US
Telephone Number	:	626-360-1118
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 S HACIENDA BLVD
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4613
Country	:	US
Telephone Number	:	626-360-1118
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	DR. XIYAO YANG
Credential	:	LAC.
Telephone Number	:	626-566-1298

Provider Enumeration Date	:	06/18/2021
Last Update Date	:	06/18/2021

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