Provider Demographics
NPI:1083632087
Name:HONG, YUAN (OMD)
Entity Type:Individual
Prefix:
First Name:YUAN
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 COLLEGE VIEW DR
Mailing Address - Street 2:#4
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6236
Mailing Address - Country:US
Mailing Address - Phone:310-893-4466
Mailing Address - Fax:
Practice Address - Street 1:3271 S SEPULVEDA BLVD
Practice Address - Street 2:#110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5221
Practice Address - Country:US
Practice Address - Phone:310-893-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10923171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist