Provider Demographics
NPI:1073704045
Name:AU-YANG, SUSAN SQ (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SQ
Last Name:AU-YANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1813
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-1813
Mailing Address - Country:US
Mailing Address - Phone:415-383-8215
Mailing Address - Fax:
Practice Address - Street 1:437 LOVELL AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1053
Practice Address - Country:US
Practice Address - Phone:415-898-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA162470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU030965Medicare PIN